Yilmaz T, Hoşal A S, Gedikoğlu G, Kaya S
Hacettepe University Faculty of Medicine, Department of Otolaryngology-Head and Neck Surgery, Ankara, Turkey.
Eur Arch Otorhinolaryngol. 1999;256(3):139-44. doi: 10.1007/s004050050127.
In this study we investigated the prognostic significance of differentiation, the mode of tumor invasion to surrounding tissues, the microscopic appearance of tumor, peritumoral lymphocytic infiltration and cartilage involvement according to disease-free survival, and the recurrence and presence of cervical lymph node metastasis in cancer of the larynx. Only the mode of tumor invasion to surrounding tissues was significantly related to survival (P < 0.05). The patients with "well-defined margin" tumors survive significantly longer than those with "groups of cells, no distinct margin." Patients with supraglottic tumors and a mode of invasion other than "well-defined margin" have a significantly higher risk of recurrence (P < 0.05) and therefore require adjuvant therapy. Patients with poorly differentiated, cartilage invading, ulcerative supraglottic tumors, and patients with glottic tumors having diffusely infiltrating margins, certainly need elective neck dissection (P < 0.05). According to the multivariant analysis, none of the factors significantly affect disease-free survival independently (P > 0.15). According to multiple logistic regression and cox regression analysis, in decreasing order of significance, the mode of invasion, microscopic tumor appearance and lymphocytic infiltration significantly affect the recurrence and time between surgery and the development of recurrence independently (P < 0.15).
在本研究中，我们根据无病生存期、喉癌的复发情况以及颈部淋巴结转移情况，调查了分化程度、肿瘤向周围组织浸润的方式、肿瘤的微观表现、肿瘤周围淋巴细胞浸润以及软骨受累情况的预后意义。只有肿瘤向周围组织浸润的方式与生存率显著相关（P < 0.05）。“边界清晰”的肿瘤患者的生存期明显长于“细胞团，无明显边界”的患者。声门上区肿瘤且浸润方式不是“边界清晰”的患者复发风险显著更高（P < 0.05），因此需要辅助治疗。分化差、侵犯软骨、溃疡型声门上区肿瘤的患者，以及声门区肿瘤边缘呈弥漫浸润性的患者，肯定需要选择性颈清扫术（P < 0.05）。根据多变量分析，这些因素均无独立显著影响无病生存期（P > 0.15）。根据多元逻辑回归和Cox回归分析，按显著性递减顺序，浸润方式、肿瘤微观表现和淋巴细胞浸润分别独立显著影响复发以及手术至复发发生的时间（P < 0.15）。
