Sessions Donald G, Lenox Jason, Spector Gershon J
Department of Otolaryngology-Head and Neck Surgery, and Head and Neck Tumor Research Project, Barnes-Jewish Hospital Foundation, St. Louis, MO 63110, U.S.A.
Laryngoscope. 2005 Aug;115(8):1402-10. doi: 10.1097/01.MLG.0000166896.67924.B7.
This study reports the results of treatment for supraglottic laryngeal cancer with nine different treatment modalities with long-term follow-up.
Retrospective study of 653 patients with supraglottic laryngeal squamous cell cancer treated from April 1955 to January 1999.
The study population included previously untreated patients with cancer of the supraglottic larynx treated with curative intent by one of nine treatment modalities and who were eligible for 5-year follow-up. The treatment modalities included subtotal supraglottic laryngectomy (SSL), SSL with neck dissection (SSL/ND), total laryngectomy (TL), TL/ND, radiation therapy (RT), SSL/RT, SSL/ND/RT, TL/RT, and TL/ND/RT. Multiple diagnostic, treatment, and follow-up parameters were studied using standard statistical analysis to determine significance.
None of the nine treatment modalities produced a survival advantage, either overall or within the stages. Overall disease specific survival (DSS) by treatment modality included SSL 88.9%, SSL/ND 75.8%, TL 83.3%, TL/ND 66.7%, RT 47.2%, SSL/RT 68.9%, SSL/ND/RT 68.1%, TL/RT 59.3%, and TL/ND/RT 46.7%. Improved DSS and cumulative disease specific survival rates were associated with patients under the age of 65 years (P = .0001), early stage disease, N0 disease (P = .0001), clear resection margins (P = .0094), and no recurrence (P = .0001). Posttreatment function showed that 90% of patients were functional in everyday life, 90.7% were eating satisfactorily, 91.4% were breathing naturally, and 83% of SSL patients, 85.7% of RT patients, and 52.8% of TL patients had "good" voices. Laryngeal preservation was accomplished in 86.1% of SSL patients and 72.7% of RT patients (P = .0190).
No treatment modality produced a survival advantage. Because SSL produced the best rate of laryngeal preservation, we recommend its use in treating the primary in eligible patients. The importance of clear resection margins is stressed. Patients with N+ disease should have the neck treated. Patients with N0 disease may be observed safely with no loss of survival advantage. Because of the pattern of recurrence and the high rates of distant metastasis and second primary cancers, follow-up for a period of not less than 8 years is recommended.
本研究报告了采用九种不同治疗方式治疗声门上型喉癌并进行长期随访的结果。
对1955年4月至1999年1月间接受治疗的653例声门上型喉鳞状细胞癌患者进行回顾性研究。
研究人群包括既往未经治疗、采用九种治疗方式之一进行根治性治疗且符合5年随访条件的声门上型喉癌患者。治疗方式包括次全声门上喉切除术（SSL）、次全声门上喉切除术加颈部清扫术（SSL/ND）、全喉切除术（TL）、全喉切除术加颈部清扫术（TL/ND）、放射治疗（RT）、SSL/RT、SSL/ND/RT、TL/RT和TL/ND/RT。使用标准统计分析研究多个诊断、治疗和随访参数以确定其显著性。
九种治疗方式均未产生总体或各阶段的生存优势。按治疗方式计算的总体疾病特异性生存率（DSS）包括：SSL为88.9%，SSL/ND为75.8%，TL为83.3%，TL/ND为66.7%，RT为47.2%，SSL/RT为68.9%，SSL/ND/RT为68.1%，TL/RT为59.3%，TL/ND/RT为46.7%。改善的DSS和累积疾病特异性生存率与年龄小于65岁的患者（P = .0001）、早期疾病、N0疾病（P = .0001）、切缘阴性（P = .0094）和无复发（P = .0001）相关。治疗后功能显示，90%的患者日常生活功能正常，90.7%的患者进食满意，91.4%的患者呼吸自然，83%的SSL患者、85.7%的RT患者和52.8%的TL患者声音“良好”。86.1%的SSL患者和72.7%的RT患者实现了喉保留（P = .0190）。
没有一种治疗方式具有生存优势。由于SSL的喉保留率最高，我们建议在符合条件的患者中用于治疗原发灶。强调切缘阴性的重要性。N+疾病患者应进行颈部治疗。N0疾病患者可安全观察，不会丧失生存优势。由于复发模式以及远处转移和第二原发癌的高发生率，建议随访不少于8年。
