Ebihara Yasuhiro, Watanabe Kenta, Fujishiro Yoshinori, Nakao Kazunari, Yoshimoto Seiichi, Kawabata Kazuyoshi, Asakage Takahiro
Department of Otorhinolaryngology, University of Tokyo, Tokyo.
Acta Otolaryngol Suppl. 2007 Dec(559):145-50. doi: 10.1080/03655230701599594.
In regard to the treatment of carcinoid tumor of the larynx, irradiation is not effective and tumor excision with a minimum surgical margin is associated with a high risk of local recurrence. Lymph node metastases to the neck are associated with worsening of the prognosis. To improve the survival rate, primary resection with a sufficient surgical margin (e.g. partial laryngectomy) and (elective) neck dissection is recommended, even for patients with early stage carcinoid tumors of the larynx.
The objective of this study was to clarify the prognostic factors, modalities of treatment for the primary lesions, and importance of neck dissection in the treatment of carcinoid tumors of the larynx.
The data of 33 cases of carcinoid of the larynx reported from Japan (including 2 of our cases) were analyzed.
The distributions of the T and N classifications of the lesions were as follows T1, 50.0%; T2, 32.2%; T3, 14.3%; T4, 3.6%; N0, 57.1%; N1, 17.9%; N2, 25.0%; and N3, 0%. Fifteen patients underwent radiation therapy, of whom five underwent curative radiotherapy. While complete remission (CR) was maintained in one of these patients (T1N0), the remaining four patients developed recurrence. Five patients underwent preoperative radiation therapy. The response to the treatment was rated as no change in four patients and as progressive disease in the remaining one patient. Among the patients with N0 disease, seven patients (43.8%) developed lymph node metastases in the neck postoperatively. Distant metastases were the most frequent cause of death in the patients. The 3-year, 5-year, and 10-year survival rates of the patients were 58.5%, 36.5%, and 12.2%, respectively. Significant differences were recognized in the survival rates between patients with and without neck lymph node involvement at the first treatment (p=0.008), and between patients with and without postoperative lymph node recurrence in the neck (p=0.037).
关于喉类癌的治疗，放疗无效，手术切缘最小的肿瘤切除与局部复发的高风险相关。颈部淋巴结转移与预后恶化相关。为提高生存率，即使对于早期喉类癌患者，也建议进行具有足够手术切缘的原发灶切除（如部分喉切除术）和（选择性）颈部清扫术。
本研究的目的是阐明喉类癌的预后因素、原发灶的治疗方式以及颈部清扫术在喉类癌治疗中的重要性。
分析了日本报道的33例喉类癌病例的数据（包括我们的2例病例）。
病变的T和N分类分布如下：T1，50.0%；T2，32.2%；T3，14.3%；T4，3.6%；N0，57.1%；N1，17.9%；N2，25.0%；N3，0%。15例患者接受了放射治疗，其中5例接受了根治性放疗。这些患者中有1例（T1N0）维持了完全缓解（CR），其余4例患者出现复发。5例患者接受了术前放疗。4例患者的治疗反应被评为无变化，其余1例患者的治疗反应被评为疾病进展。在N0期疾病患者中，7例患者（43.8%）术后出现颈部淋巴结转移。远处转移是患者最常见的死亡原因。患者的3年、5年和10年生存率分别为58.5%、36.5%和12.2%。首次治疗时颈部淋巴结受累患者与未受累患者之间的生存率存在显著差异（p = 0.008），颈部术后淋巴结复发患者与未复发患者之间的生存率也存在显著差异（p = 0.037）。
