Abstract
ObjectiveTo compare the surgical outcomes of carotid body tumor (CBT) with or without pathological fibrosis, and evaluate the associated factors of fibrous CBT (FCBT).Materials and MethodsParaffin-embedded tissues of 236 patients with unilateral CBTs at our center were retrospectively reviewed from January 2008 to May 2020. Based on the pathologic features, CBTs were divided into FCBT and conventional CBT (CCBT) groups. The clinical data and surgical outcomes of the two groups were compared.ResultsOf 236 patients, 53 had FCBT and 183 had CCBT. FCBTs showed higher vascular invasion (24.53%), marked pleomorphism (22.64%), internal carotid artery reconstruction (37.74%), estimated blood loss (559.62 cm3), and postoperative nerve injury (49.06%), with lower 10-year recurrence- (89.2%) and major adverse event-free survival (87.3%) compared to CCBTs. Nerve injury was correlated with the Shamblin grade; major adverse events and nerve injury were both correlated with pathological fibrosis.ConclusionCompared with CCBT, FCBT is prone to increased recurrence, metastasis, major adverse events, and nerve injury risk. Early surgical resection, routine excision of surrounding abnormal lymph nodes, and closer clinical surveillance in FCBT patients are recommended.
Highlights
Carotid body tumors (CBTs) are typically benign, slow-growing tumors arising from neuroectodermal crest-derived paraganglia [1,2,3]
We studied a total of 236 unilateral CBT samples; 53 were fibrous carotid body tumor (FCBT) and 183 were conventional CBT (CCBT)
No significant differences were observed between FCBT and CCBT patients in age, sex, smoking, or comorbidities including hypertension, diabetes, hyperlipidemia, and cardiovascular disease (Table 1)
Summary
Carotid body tumors (CBTs) are typically benign, slow-growing tumors arising from neuroectodermal crest-derived paraganglia [1,2,3]. CBTs can be classified by etiology, anatomy, and genetic mutations. Hyperplastic CBTs are Abbreviations: CBT, Carotid body tumor; CCA, common carotid artery; CCBT, conventional carotid body tumors; CN, cranial nerve; EBL, established blood loss; ECA, external carotid artery; FCBT, fibrous carotid body tumor; H&E, hematoxylin and eosin; ICA, internal carotid artery; MRI, magnetic resonance imaging; SDHx, subunits of succinate dehydrogenase. The anatomical classification by Shamblin et al [3], designed as a predictor of intra-operative technical difficulty [5], is the most clinically relevant, because it describes the extent of envelopment of the common carotid artery (CCA), internal carotid artery (ICA), and external carotid artery (ECA) by CBT. Genetic carriers of subunits of succinate dehydrogenase (SDHx) mutations present a higher risk of tumors for the autonomic nervous system. Tumor function, age of onset, risk of malignant diseases, and transmission vary by genotype [6, 7]
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