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Abstract
Objectives: To assess the prognosis of initial endoscopic surgery in T1N0M0 and T2N0M0 staged NPC patients.
Materials and methods: Between 2002 and 2016, 10 previously untreated patients with T1N0M0 or T2N0M0 staged NPC volunteered to receive endoscopic surgery followed by four courses of TPF chemotherapy. EORTC QLQ-C30 and QLQ-H&N35 were used to evaluate the QOL after treatment.
Results: With the median follow-up of 30 months (range, 9 months to 128 months), the 24-month survival rate was 100% (6/6), 90% (9/10) patients were still alive and well, 20% (2/10) patients reported tumor recurrence. One died of the disease at 128 months with nasopharyngeal recurrence. Another patient who refused preoperative PET-CT had a cervical recurrence at nine months, accepted nasopharynx and neck radiation two months later and was still alive and well at 50 months. In the post-treatment questionnaires, several NPC-specific (pain, swallowing, speech, social eating, opening mouth, dry mouth, sticky saliva) QOL domains were better preserved compared with radiotherapy alone or combined chemoradiotherapy in other surveys.
Conclusions: Initial endoscopic surgery combined with chemotherapy maybe justified in the hands of highly experienced surgeon in selected early-stage NPC cases and can improve their QOL. In addition, preoperative PET-CT should be included in case of possible minimal metastases.
Chinese abstract
目的：人乳头状瘤病毒（HPV）已知与口咽鳞状细胞癌（OPSCC）相关, 可能在肿瘤转移中起重要作用。本研究的目的是找出颈淋巴结转移的HPV状态与其各自的原发性OPSCC肿瘤的相关性。
方法：采用HPV16 DNA聚合酶链反应（PCR）, p16免疫组织化学和HPV分型方法, 分析34例颈淋巴结转移患者的经福尔马林固定和石蜡包埋（FFPE）的组织样本。其结果与OPSCC原发性肿瘤中发现的HPV状态和类型相关。
结果：通过比较HPV DNA与p16的差异, 我们发现21例原发性肿瘤和淋巴结转移为HPV阳性（61.8％）, 7例原发性肿瘤和淋巴结转移为HPV阴性（20.6％）。当原发性肿瘤和淋巴结转移相关时, 6例患者的样本不同（17.6％）。
结论：本研究中, 绝大多数病例的OPSCC中的HPV状态和颈淋巴结转移的相关。然而, HPV检测方法可能具有某些限制, 导致不同程度的非相关性。分级治疗时应考虑HPV状态。
Acknowledgements
The authors acknowledge and thank the volunteers, the team of Otorhinolaryngology Department of Guangdong General Hospital for their help and support. They also thank the Institutional Review Board of Guangdong Academy of Medical Sciences.
Disclosure statement
The authors declare that there is no conflict of interests regarding the publication of this paper. Funding source had no involvement in study design, data collection and analysis.