Chiu Robert J, Myers Eugene N, Johnson Jonas T
University of Pittsburgh School of Medicine and Eye and Ear Institute, Pittsburgh, PA, USA.
Otolaryngol Head Neck Surg. 2004 Oct;131(4):485-8. doi: 10.1016/j.otohns.2004.04.024.
In a previous study, we reported that the contralateral undissected neck was the most common site of failure in patients treated for squamous cell carcinoma of the supraglottic larynx. Since then, we have altered our treatment of all patients with T2-T4 supraglottic cancer and selective T1 cases to include routine bilateral neck dissection. In the present study, we compare the long-term efficacy of routine bilateral neck dissections to historic controls in the treatment of patients with supraglottic cancer.
A retrospective chart review on all patients undergoing primary surgery for supraglottic carcinoma between 1989 and 2000 was performed. All had undergone routine bilateral neck dissection. The most proximal area of recurrent disease was identified as the site of recurrence. Rates of recurrence, 2-year overall survival, and 2-year disease-specific survival were calculated. Results were compared to historical data using Fisher's exact test.
Of 180 patients identified, 115 patients with minimum 2-year follow-up and meeting exclusion criteria were included in the analysis. Four patients (3.5%) experienced local recurrence, 9 patients (7.8%) had cervical recurrence, and 8 patients had distant spread (7.0%). Recurrence in the neck (7.8%) has been significantly reduced from the historical recurrence rate (20%) prior to instituting routine bilateral neck dissections ( P = 0.009). The 2-year survival increased from 72% to 82.6% ( P = 0.0408).
Routine bilateral neck dissection decreases cervical recurrence and appears to improve survival in the management of supraglottic cancer.
在之前的一项研究中，我们报告称，声门上型喉鳞状细胞癌患者治疗失败最常见的部位是对侧未行清扫的颈部。自那时起，我们改变了对所有T2 - T4期声门上癌患者以及部分选择性T1期病例的治疗方案，将常规双侧颈部清扫纳入其中。在本研究中，我们比较了常规双侧颈部清扫与历史对照在声门上癌患者治疗中的长期疗效。
对1989年至2000年间所有接受声门上癌原发手术的患者进行了回顾性病历审查。所有患者均接受了常规双侧颈部清扫。将复发性疾病最靠近头端的区域确定为复发部位。计算复发率、2年总生存率和2年疾病特异性生存率。使用Fisher精确检验将结果与历史数据进行比较。
在确定的180例患者中，115例至少有2年随访且符合排除标准的患者纳入分析。4例患者（3.5%）出现局部复发，9例患者（7.8%）出现颈部复发，8例患者出现远处转移（7.0%）。颈部复发率（7.8%）较开展常规双侧颈部清扫前的历史复发率（20%）显著降低（P = 0.009）。2年生存率从72%提高到82.6%（P = 0.0408）。
常规双侧颈部清扫可降低颈部复发率，且似乎能提高声门上癌治疗的生存率。
