喉声门和声门上区癌与颈部转移相关的治疗

Yücetürk Ali Vefa, Celik Onur, Eskiizmir Görkem

Department of Otolaryngology, Medicine Faculty of Celal Bayar University, Manisa, Turkey.

Kulak Burun Bogaz Ihtis Derg. 2003 Nov;11(5):129-33.

OBJECTIVES

We evaluated the management of glottic and supraglottic laryngeal cancers in relation to neck metastasis.

PATIENTS AND METHODS

Fifty-two patients (51 males, 1 female; mean age 59.2 years; range 27 to 82 years) underwent surgery for primary laryngeal cancers. Preoperative and postoperative TNM classification and staging were made according to the AJCC 1997 criteria. The mean follow-up period was 39.4 months (range 6 to 74 months).

RESULTS

The tumors were glottic in 31 patients and supraglottic in 21 patients. Laryngectomies were partial in 34 patients and total in 18 patients. All the patients with supraglottic tumors and those with glottic T2-4 tumors underwent neck dissection, as well. Radiotherapy was administered to 22 patients with established N2 or N3 tumors. Clinical assessment was in agreement with the pathological result in 63.5%; 13.5% and 23.1% of cases were underdiagnosed and overdiagnosed, respectively. The rates of neck metastasis were 0% in T1, 25% in T2, 75% in T3, and 66.7% in T4 supraglottic tumors. The corresponding rates for glottic cancers were 0%, 16.7%, 28.6%, and 60%, respectively. The overall rate of N+ tumors was 28.9%. Four patients (7.7%) developed local, two patients (3.9%) developed regional recurrences. Mortality occurred in eight patients (15.4%) due to following causes: laryngeal recurrence (T4N2, T4N2, T3N1), regional recurrence (T4N2), a second primary malignancy in one patient, and other causes in three patients. Five- and two-year disease-specific survival rates (Kaplan-Meier analysis) were 90.7%, and overall survival rates were 73.7% and 87.3%, respectively.

CONCLUSION

Neck metastasis and advanced stage of the tumor were the most effective prognostic factors.

目的

我们评估了声门型和声门上型喉癌与颈部转移相关的治疗情况。

患者与方法

52例患者（51例男性，1例女性；平均年龄59.2岁；范围27至82岁）接受了原发性喉癌手术。术前和术后TNM分类及分期根据美国癌症联合委员会（AJCC）1997年标准进行。平均随访期为39.4个月（范围6至74个月）。

结果

31例患者肿瘤为声门型，21例为声门上型。34例行部分喉切除术，18例行全喉切除术。所有声门上型肿瘤患者及声门型T2 - 4肿瘤患者也均接受了颈部清扫术。22例确诊为N2或N3期肿瘤的患者接受了放疗。临床评估与病理结果相符率为63.5%；分别有13.5%和23.1%的病例诊断不足和诊断过度。声门上型肿瘤T1期颈部转移率为0%，T2期为25%，T3期为75%，T4期为66.7%。声门型癌相应转移率分别为0%、16.7%、28.6%和60%。N + 肿瘤总体发生率为28.9%。4例患者（7.7%）发生局部复发，2例患者（3.9%）发生区域复发。8例患者（15.4%）死亡，原因如下：喉复发（T4N2、T4N2、T3N1）、区域复发（T4N2）、1例患者发生第二原发性恶性肿瘤，3例患者因其他原因死亡。5年和2年疾病特异性生存率（Kaplan - Meier分析）分别为90.7%，总体生存率分别为73.7%和87.3%。