Chone Carlos T, Yonehara Ema, Martins Jose E F, Altemani Albina, Crespo Agricio N
Division of Otolaryngology-Head and Neck Surgery, Universidade Estadual de Campinas, Av. Heitor Penteado 1541, 13087-000 Campinas, São Paulo, Brazil.
Arch Otolaryngol Head Neck Surg. 2007 Sep;133(9):882-7. doi: 10.1001/archotol.133.9.882.
To analyze the impact of anterior commissure involvement on rates of local control, recurrence, and laryngeal preservation in patients with early glottic cancer (T1a-T2 lesions, staged according to the TNM staging system) treated with laser microsurgical resection.
Retrospective review.
A tertiary university referral center.
Forty-eight patients with early glottic (T1-T2a) cancer.
Laser endoscopic resection of glottic cancer.
Evaluation of local control and larynx preservation rates.
Among 48 patients presenting with early glottic cancer, the anterior commissure was involved in 24 cases. The local control rate was 79% (19 cases), and the larynx preservation rate was 96% (23 cases). In the 24 cases without anterior commissure involvement, the local control rate was 96% (23 cases) and the corresponding larynx preservation rate was 100% (24 cases). The rate of local recurrence with anterior commissure involvement was 21% (5 cases) and was 4% (1 case) when this site was not compromised by the tumor. This difference was not statistically significant (P = .08). When the anterior commissure was compromised by a lesion, more surgical margins taken from the patient after the completion of surgery (additional margins) were compromised by squamous cell carcinoma (SCC) on permanent section (33% [8 cases]) compared with 0% from patients with anterior commissure involvement (P = .003), despite the fact that these margins were negative for disease on frozen section. Cases with additional margins compromised by SCC on permanent section (P = .004) and T1 lesions (P = .009) had a higher rate of recurrence.
This study shows the tendency toward greater additional margins compromised by SCC and a higher rate of tumor recurrence in lesions with anterior commissure involvement after laser microsurgery for early glottic carcinoma. Higher recurrence rates were observed in cases with compromised additional margins and in T1 cases.
分析前联合受累对接受激光显微手术切除的早期声门癌（根据TNM分期系统分期为T1a - T2病变）患者的局部控制率、复发率和喉保留率的影响。
回顾性研究。
一所三级大学转诊中心。
48例早期声门癌（T1 - T2a）患者。
激光内镜下切除声门癌。
评估局部控制率和喉保留率。
48例早期声门癌患者中，24例前联合受累。局部控制率为79%（19例），喉保留率为96%（23例）。在24例无前联合受累的病例中，局部控制率为96%（23例），相应的喉保留率为100%（24例）。前联合受累时局部复发率为21%（5例），该部位未受肿瘤侵犯时复发率为4%（1例）。这种差异无统计学意义（P = 0.08）。当病变累及前联合时，术后取自患者的更多手术切缘（额外切缘）在永久切片上被鳞状细胞癌（SCC）累及（33%[8例]），而无前联合受累患者的这一比例为0%（P = 0.003），尽管这些切缘在冰冻切片上无疾病表现。永久切片上额外切缘被SCC累及的病例（P = 0.004）和T1病变（P = 0.009）复发率更高。
本研究表明，早期声门癌激光显微手术后，前联合受累的病变中，SCC累及额外切缘的倾向更大，肿瘤复发率更高。额外切缘受累的病例和T1病例观察到更高的复发率。
