Background: Individually personalized reconstructive microsurgery is more and more universally recognized and applied as a one-time, part of a few, or even the only highly effective treatment of patients with locally advanced midface cancer. Among the increasing number of publications focused on this field, most present different reconstructive techniques used for a single patient (case reports), and fewer papers evaluate a group including more than 100 patients. Methods: A dataset of 119 locally advanced midface cancers in stage T3or T4was used to analyze whether there is any correlation between clinical factors, resection defect parameters, and the free flaps chosen for reconstruction. Results: In general, the 5-year OS was 95% and 77% for the DFS, which inversely correlated with the increasing Cordeiro’s type of resective defects. Local recurrence occurred in 23% of cases. Taxonomic dendrograms allow the selection of four (A–D) different case clusters. Cluster B, which characterizes a tumor size of 8–18 cm2, Cordeiro type IIIA, and an uncertain radicalism of resection, has the worst prognosis with a very high (89%) risk of local recurrence. On the contrary, the most favorable was found in cluster C, characterized by Cordeiro type IIA, a tumor size of 8 cm2, and negative resective margins, because it has a very low (6%) risk of local recurrence. Conclusions: The results of the present analysis have led to design algorithms for midface resection and reconstruction. However, these should not be considered obligatory but rather as a useful general guideline.
背景：个体化重建显微外科手术作为一种一次性、少数几次甚至唯一高效的治疗手段，在局部晚期中面部癌症患者中日益得到广泛认可和应用。在该领域日益增多的文献中，大多数研究呈现了针对单个患者采用的不同重建技术（病例报告），而评估超过100例患者群体的研究相对较少。 方法：本研究采用包含119例T3或T4期局部晚期中面部癌症的数据集，分析临床因素、切除缺损参数与重建所选用的游离皮瓣之间是否存在相关性。 结果：总体而言，5年总生存率为95%，无病生存率为77%，后者与Cordeiro分型切除缺损程度的增加呈负相关。局部复发率为23%。通过分类树状图可筛选出四个（A–D）不同的病例聚类。其中B类聚类（肿瘤大小为8–18 cm²、Cordeiro IIIA型且切除根治性不确定）预后最差，局部复发风险极高（达89%）。相反，预后最佳的是C类聚类（Cordeiro IIA型、肿瘤大小为8 cm²且切除边缘阴性），其局部复发风险极低（仅6%）。 结论：本分析结果有助于设计中面部切除与重建的算法流程。但需注意，这些算法不应被视为强制性标准，而应作为有益的通用指导原则。
肿瘤(癌症)患者之家