Morshed Kamal, Szymański Marcin, Zadrozniak Marek, Siwiec Henryk, Wawrzecka Agnieszka, Tarasiuk Agnieszka, Abushammalah Rashad, Smoleń Agata
Klinika Otolaryngologii i Onkologii, Laryngologicznej Uniwersytetu Medycznego w Lublinie.
Otolaryngol Pol. 2009 Sep-Oct;63(5):419-28. doi: 10.1016/S0030-6657(09)70154-4.
The aim of the present study was to investigate the recurrence prevalence in patients with laryngeal squamous cell carcinoma (LSCC) underwent surgery as primary treatment.
The assessed group consisted of 148 patients with operable LSCC underwent surgery as primary treatment between 1999-2002. Surgery was performed in all cases. Total laryngectomy was performed in 107 (72.3%) patients and laser endoscopic tumor resection was performed in 41 (27.7%) patients.
Local recurrence occurred in 18 (12.2%) patients, nodal recurrence in 12 (8.1%) and both and/or remote metastases in 6 (4%) patients. Altogether, recurrence was present in 36 (24.3%) patients and 111 (75.7%) patients had no symptoms of recurrence. Recurrence prevalence in 3-year follow-up--prevalence of recurrence significantly increased with tumor's T feature (p=0.04), N feature (p=0.03), progression of clinical stage (p=0.008) and histological malignancy G stage (p=0.01). Recurrence prevalence in 5-year follow-up--prevalence of recurrence significantly increased with tumor's T feature (p=0.02), N feature (p=0.01), progression of clinical stage (p=0.003) and histological malignancy G stage (p=0.002). Tumors localized in glottic area had less recurrences than those localized in supraglottic area (p=0.05). There were no significant dependence between recurrence type (local or nodal) and tumor's clinicopathological features. Multiple factor analysis with logistic regression model did not revealed simultaneous influence of many variables on recurrence's presence and type. Using multiple factor analysis with Cox's regression model it was proved that recurrence presence (p<0.00001) is a significant independent prognostic factor in the analyzed group of patients with laryngeal carcinoma in 3-year follow-up.
Recurrence prevalence depends on localization, systemic progression stage, clinical progression stage, cervical lymph nodes state and histological malignancy stage of tumor. Patients with local recurrence have statistically significantly worse prognosis than patients with no recurrence. Recurrence presence is significant independent prognostic factor in 3-year follow-up.
本研究旨在调查接受手术作为主要治疗手段的喉鳞状细胞癌（LSCC）患者的复发率。
评估组由1999年至2002年间接受手术作为主要治疗手段的148例可手术切除的LSCC患者组成。所有病例均接受了手术。107例（72.3%）患者行全喉切除术，41例（27.7%）患者行激光内镜肿瘤切除术。
18例（12.2%）患者发生局部复发，12例（8.1%）发生淋巴结复发，6例（4%）患者发生局部和/或远处转移。总计，36例（24.3%）患者出现复发，111例（75.7%）患者无复发症状。3年随访期内的复发率——复发率随肿瘤的T特征（p = 0.04）、N特征（p = 0.03）、临床分期进展（p = 0.008）和组织学恶性程度G分期（p = 0.01）显著增加。5年随访期内的复发率——复发率随肿瘤的T特征（p = 0.02）、N特征（p = 0.01）、临床分期进展（p = 0.003）和组织学恶性程度G分期（p = 0.002）显著增加。声门区肿瘤的复发率低于声门上区肿瘤（p = 0.05）。复发类型（局部或淋巴结）与肿瘤的临床病理特征之间无显著相关性。逻辑回归模型的多因素分析未显示多个变量对复发的存在和类型有同时影响。使用Cox回归模型的多因素分析证明，在3年随访期内，复发的存在（p < 0.00001）是分析的喉癌患者组中的一个显著独立预后因素。
复发率取决于肿瘤的定位、全身进展期、临床进展期、颈部淋巴结状态和组织学恶性程度分期。局部复发患者的预后在统计学上显著差于无复发患者。在3年随访期内，复发的存在是一个显著的独立预后因素。
