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A Survival Analysis

Alexander C. Vlantis, FCS(SA)ORL; Raymond K. Y. Tsang, FRCS(Edin)(ORL); Brian K. H. Yu, FRCR; Michael K. M. Kam, FRCR; Michael C. F. Tong, FRCS(Edin)(ORL); Phoebe S. Y. Lo, MSc; C. Andrew van Hasselt, MMed(Otol)

Arch Otolaryngol Head Neck Surg. 2007;133(12):1296-1301.

Objective  To explore whether the margin status at surgical salvage nasopharyngectomy for local residual or recurrent nasopharyngeal carcinoma affects patient survival.

Design  Retrospective case series review.

Setting  Academic tertiary referral center.

Patients  Seventy-nine consecutive patients with operable local residual or recurrent nasopharyngeal carcinoma after failure of primary treatment with radiotherapy with or without chemotherapy underwent surgical salvage nasopharyngectomy with curative intent between November 28, 1987, and November 17, 2003. Sixty-one patients were men and 18 were women. Their mean age was 48 years (age range, 26-70 years).

Intervention  Surgical salvage nasopharyngectomy.

Main Outcome Measures  The status of the closest margin at surgery was assessed as clear, close, or positive. Survival time was measured from the date of surgery to the date of the last follow-up, to the date of an event occurrence, or to the date of death. The Kaplan-Meier method was used to estimate the probability of local progression-free survival and overall survival at 5 years. Differences in survival rates between surgical margin statuses were assessed using the log-rank test.

Results  Five-year overall survival for patients with clear margins was 77%, for patients with close margins was 46% (P = .05), and for patients with positive margins was 23% (P < .001).

Conclusion  Clear surgical margins at the time of surgical salvage nasopharyngectomy for residual or recurrent nasopharyngeal carcinoma positively affect patient survival.

Author Affiliations: Departments of Otorhinolaryngology, Head and Neck Surgery (Drs Vlantis, Tsang, Tong, and van Hasselt and Ms Lo), and Clinical Oncology (Drs Yu and Kam), Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.