Prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer
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摘要: 目的 研究不同肿瘤扩展模式在T3期声门型喉癌手术治疗中的预后影响。方法 对91例T3期声门型喉癌患者的临床资料进行了回顾性分析。结果 91例患者中，前侵犯58例(63.7%)，后侵犯33例(36.3%)，后侵犯与环状软骨背板(P < 0.001)、杓状软骨(P=0.001)、声门下(P=0.001)侵犯显著相关。部分喉切除组与全喉切除组生存结局差异无统计学意义；部分喉切除组中前侵犯肿瘤5年无病生存率优于后侵犯肿瘤(HR：4.681，95%CI 1.337~16.393，P=0.016)，声门下侵犯与较差的5年局部区域无复发生存率相关(HR：3.931，95%CI 1.054~14.658，P=0.041)。同时，还发现环状软骨背板侵犯是部分喉切除术后发生喉狭窄的独立危险因素(HR：11.67，95%CI 1.89~71.98，P=0.008)。结论 经选择的部分喉切除术较全喉切除术同样能获得良好的肿瘤学结果。后侵犯和声门下侵犯是T3期声门型喉癌部分喉手术复发的独立预后因素，环状软骨背板侵犯与部分喉术后喉狭窄相关。应进一步细分喉癌患者的肿瘤侵犯模式，以选择更为个体化的治疗方案。Abstract: Objective To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer.Methods A retrospective analysis was conducted on the clinical data of 91 patients with T3 glottic laryngeal cancer.Results Among the 91 patients, 58 cases (63.7%) had anterior invasion and 33 cases (36.3%) had posterior invasion. The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage (P < 0.001), arytenoid cartilage (P= 0.001), and subglottic region(P = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group. But in the partial laryngectomy group, the 5-year disease-free survival(DFS) of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors (HR: 4.681, 95%CI 1.337-16.393, P=0.016), and subglottic invasion was associated with worse loco-regional recurrence-free survival(LRRFS)(HR: 3.931, 95%CI 1.054-14.658, P=0.041). At the same time, we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients (HR: 11.67, 95%CI 1.89-71.98, P=0.008).Conclusion Compared with total laryngectomy, selected partial laryngectomy can also achieve favorable oncological outcomes. Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer, and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.
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Key words:
- laryngeal neoplasms /
- neoplasm invasion /
- laryngectomy /
- prognosis
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表 1 91例T3期声门型喉鳞状细胞癌的人口特征
变量 例数(%) 变量 例数(%) 年龄/岁 查尔森指数 < 60 40(44.0) 1 11(12.1) ≥60 51(56.0) 2 24(26.4) 性别 3 33(36.3) 男 91(100.0) 4 21(23.1) 女 0 5 0 吸烟史 6 2(2.2) 是 85(93.4) N分期 否 6(6.6) N0 77(84.6) 饮酒史 N1 11(12.1) 是 65(71.4) N2 3(3.3) 否 26(28.6) N3 0 临床分期 M分期 Ⅲ 88(96.7) M0 91(100.0) Ⅳ 3(3.3) 
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表 2 不同分组肿瘤前后侵犯特征
例(%) 变量 整个研究人群(n=91) 部分喉(n=55) 全喉(n=36) 前侵犯 后侵犯 P 前侵犯 后侵犯 P 前侵犯 后侵犯 P 例数 58(63.7) 33(36.3) 44(80.0) 11(20.0) 14(38.9) 22(61.1) N分期 0.245 0.558 0.712 N0 51(87.9) 26(78.8) 41(93.2) 9(81.8) 10(71.4) 17(77.3) N+ 7(12.1) 7(21.2) 3(6.8) 2(18.2) 4(28.6) 5(22.7) 颈清类型 0.051 0.832 0.908 单侧 34(58.6) 17(51.5) 28(63.6) 8(72.7) 6(42.9) 9(40.9) 双侧 24(41.4) 16(48.5) 16(36.4) 3(27.3) 8(57.1) 13(59.1) 辅助治疗 0.796 0.176 0.733 否 30(51.7) 18(54.5) 22(50.0) 8(72.7) 8(57.1) 10(45.5) 是 28(48.3) 15(45.5) 22(50.0) 3(27.3) 6(42.9) 12(54.5) 声带固定 0.005 0.001 0.596 否 36(62.1) 9(27.3) 32(72.7) 2(18.2) 4(28.6) 7(31.8) 欠佳 9(15.5) 8(24.2) 5(11.4) 5(45.5) 4(28.6) 3(13.6) 是 13(22.4) 16(48.5) 7(15.9) 4(36.4) 6(42.9) 12(54.5) 环状软骨背板 ＜0.001 ＜0.001 0.002 否 56(96.6) 16(48.5) 42(95.5) 5(45.5) 14(100.0) 11(50.0) 是 2(3.4) 17(51.5) 2(4.5) 6(54.5) 0(0) 11(50.0) 杓状软骨 0.001 0.614 0.025 否 56(96.6) 23(69.7) 43(97.7) 11(100.0) 13(92.9) 12(54.5) 是 2(3.4) 10(30.3) 1(2.3) 0 1(7.1) 10(45.5) 会厌前间隙 0.405 0.785 0.755 否 45(77.6) 23(69.7) 36(81.8) 10(90.9) 9(64.3) 13(59.1) 是 13(22.4) 10(30.3) 8(18.2) 1(9.1) 5(35.7) 9(40.9) 声门下 0.001 0.021 0.932 否 41(70.7) 11(33.3) 37(84.1) 5(45.5) 4(28.6) 6(27.3) 是 17(29.3) 22(66.7) 7(15.9) 6(54.5) 10(71.4) 16(72.7)
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表 3 部分喉切除组单因素生存分析
变量 OS/% P DSS/% P LRRFS/% P DFS/% P N分期 0.321 0.577 0.900 0.999 N0 90.8 95.4 81.1 79.0 N+ 100.0 100.0 80.0 80.0 颈清类型 0.981 0.881 0.559 0.762 单侧 90.6 96.7 82.7 79.9 双侧 94.1 94.1 75.7 75.7 辅助治疗 0.573 0.342 0.145 0.082 否 91.6 91.6 76.0 72.1 是 91.6 100.0 89.3 89.3 前后侵犯 0.759 0.455 0.042 0.008 前侵犯 91.9 97.2 89.5 89.5 后侵犯 90.0 90.0 35.8 31.2 环状软骨背板 0.229 0.425 0.132 0.205 否 90.2 95.1 85.1 82.9 是 100.0 100.0 62.5 62.5 杓状软骨 0.514 0.682 0.562 0.548 否 91.4 95.7 80.6 78.7 是 100.0 100.0 100.0 100.0 会厌前间隙 0.38 0.401 0.673 0.569 否 92.2 97.3 79.9 77.6 是 88.9 88.9 88.9 88.9 声门下 0.396 0.334 0.028 0.062 否 89.0 94.4 92.6 89.9 是 100.0 100.0 50.3 50.3
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