Caballero Miguel, Vilaseca Isabel, Bernal-Sprekelsen Manuel, Guilemany Jose M, Moragas Miguel, Blanch Jose Luís
Department of Otorhinolaryngology and Head & Neck Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Head Neck. 2008 Dec;30(12):1599-606. doi: 10.1002/hed.20921.
Transoral CO(2) laser microsurgery (TLM) resection of laryngeal-hypopharyngeal squamous cell carcinomas has become a standard procedure. The objective was to evaluate whether there is a relationship between TLM and a higher incidence of distant metastases.
We conducted a retrospective analysis of 340 consecutive patients with laryngeal or hypopharyngeal squamous cell carcinoma treated with TLM.
Distant metastases occurred in 24 of 340 (7.1%) patients. The mean time of distant metastases diagnosis was 19.1 months (range, 1-41) postsurgery. Univariate study demonstrated an association with alcoholism (p = .008), tumor site (p<.001), grade of differentiation (p = .032), stage (p<.001), tumor classification (T; p = .001), node involvement (N; p<.001), extracapsular node spread (p<.001), and positive surgical margin (p = .004). In multivariate logistic regression analysis, location (sinus piriform: OR = 15.37, p = .025), node involvement (N2: OR = 7.36, p = .003; N3: OR = 19.28, p = .027), and the affected surgical margin (OR 5.32; p = .005) predicted an increased likelihood of distant metastases.
Development of distant metastases after TLM in patients with squamous cell carcinoma depends mainly on the tumor site, the presence of metastatic lymph node disease, and the margin status after resection.
经口二氧化碳激光显微手术（TLM）切除喉下咽鳞状细胞癌已成为一种标准手术。目的是评估TLM与远处转移发生率较高之间是否存在关联。
我们对340例连续接受TLM治疗的喉或下咽鳞状细胞癌患者进行了回顾性分析。
340例患者中有24例（7.1%）发生远处转移。远处转移诊断的平均时间为术后19.1个月（范围1 - 41个月）。单因素研究表明与酗酒（p = 0.008）、肿瘤部位（p<0.001）、分化程度（p = 0.032）、分期（p<0.001）、肿瘤分类（T；p = 0.001）、淋巴结受累（N；p<0.001）、包膜外淋巴结扩散（p<0.001）及手术切缘阳性（p = 0.004）有关。在多因素逻辑回归分析中，部位（梨状窦：OR = 15.37，p = 0.025）、淋巴结受累（N2：OR = 7.36，p = 0.003；N3：OR = 19.28，p = 0.027）及手术切缘受累（OR = 5.32；p = 0.005）预示远处转移可能性增加。
鳞状细胞癌患者TLM术后远处转移的发生主要取决于肿瘤部位、转移性淋巴结疾病的存在及切除后的切缘状态。
