Viani L, Stell P M, Dalby J E
Department of Otorhinolaryngology, University of Liverpool, England.
Cancer. 1991 Feb 1;67(3):577-84. doi: 10.1002/1097-0142(19910201)67:3<577::aid-cncr2820670309>3.0.co;2-w.
A series of 478 patients with T1-3N0 glottic carcinoma treated by irradiation is presented. Of these patients, 320 were previously untreated, whereas 158 patients were referred for treatment of a recurrence after receiving radiotherapy elsewhere. The primary recurrence rate in the previously untreated patients was 10%. The rate was higher in T2 and T3 tumors, poorly differentiated tumors, and in patients who were in poor general condition. Over 80% of the recurrent tumors were Stage pT3 or pT4, whereas 12% of total laryngectomy specimens showed necrosis only with no evidence of tumor. The necrosis rate in previously untreated patients was 1% for T1 tumors, 4% for T2 tumors, and 3% for T3 tumors. Of all tumors, 60% were transglottic when they recurred, whereas only 29% were confined to the glottis at recurrence. Histologic diagnosis had a high sensitivity but a low specificity, indicating that a negative histologic report is unreliable. Of patients with a recurrent primary tumor, 13% were untreatable. The 5-year survival after a primary recurrence was 39%, and the main prognostic factors were sex, T stage at recurrence, and time to recurrence. Of patients available for follow-up at 5 years 49% were alive with a larynx, 5% were alive without a larynx, 13% were dead of the original cancer, and 33% had died of other causes. In those suffering a primary recurrence, the commonest cause of death was a subsequent lymph node metastasis, followed in order of frequency by stomal recurrence and recurrence in the pharyngeal remnant. The hospital mortality rate after laryngectomy was 3%, and 30% of patients undergoing laryngectomy developed a pharyngocutaneous fistula. The recurrence rate in lymph nodes was 14% at 5 years, general condition and T stage being the only significant predictors of recurrence. Only 17% of patients had small (N1) nodes by the time the diagnosis of cervical lymph node recurrence was made, and 27% of all patients were unsuitable for treatment. Host, tumor factors, and time to recurrence were not significant predictors of survival after node recurrence. The survival rate 5 years after node recurrence was 16%, and the main cause of death in those who died was uncontrolled disease in the neck. The hospital mortality after salvage neck dissection was 4.7%.
本文报告了478例接受放疗的T1-3N0声门癌患者。其中，320例患者此前未接受过治疗，而158例患者是在其他地方接受放疗后复发前来接受治疗。此前未接受过治疗的患者的原发复发率为10%。T2和T3肿瘤、低分化肿瘤以及全身状况较差的患者复发率更高。超过80%的复发性肿瘤为pT3或pT4期，而12%的全喉切除标本仅显示坏死，无肿瘤证据。此前未接受过治疗的患者中，T1肿瘤的坏死率为1%，T2肿瘤为4%，T3肿瘤为3%。所有肿瘤复发时，60%为跨声门型，而复发时仅29%局限于声门。组织学诊断敏感性高但特异性低，这表明组织学报告为阴性并不可靠。原发肿瘤复发的患者中，13%无法治疗。原发复发后的5年生存率为39%，主要预后因素为性别、复发时的T分期和复发时间。在5年可随访的患者中，49%喉存活，5%无喉存活，13%死于原发癌，33%死于其他原因。在原发复发的患者中，最常见的死亡原因是随后发生的淋巴结转移，其次依次为吻合口复发和咽残端复发。喉切除术后的医院死亡率为3%，接受喉切除术的患者中有30%发生咽皮肤瘘。5年时淋巴结复发率为14%，全身状况和T分期是复发的唯一重要预测因素。在诊断为颈部淋巴结复发时，只有17%的患者有小（N1）淋巴结，所有患者中有27%不适合治疗。宿主、肿瘤因素和复发时间不是淋巴结复发后生存的重要预测因素。淋巴结复发后5年生存率为16%，死亡患者的主要死亡原因是颈部疾病无法控制。挽救性颈清扫术后的医院死亡率为4.7%。
