Cho Kwang Jae, Sun Dong Il, Joo Young Hoon, Kim Min Sik
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Auris Nasus Larynx. 2011 Apr;38(2):255-60. doi: 10.1016/j.anl.2010.07.002. Epub 2010 Aug 19.
The aim of this study is to evaluate the impact of pre-operative T-understaging on clinical outcome in supracricoid partial laryngectomy (SCPL).
The medical records of 92 patients who underwent SCPL were evaluated. By comparing clinical and pathologic stages, the causes of pre-operative T-understaging and its relationship with local recurrence and survival were examined.
Fifteen patients (16.3%) were found to be underestimated in terms of pre-operative T-stage, primarily due to failure to identify thyroid cartilage invasion (11 cases). Among these, radiation treatment at the primary site was offered in only two cases, including one case with a positive surgical margin. Among 82 patients followed for over 1 year, local recurrence occurred in seven patients (8.5%); five of these (71.4%) had been understaged pre-operatively due to failure to detect thyroid cartilage invasion. The local recurrence rate was higher and the overall survival rate was lower in patients who were understaged pre-operatively, compared to those who were staged accurately (p=0.006 and p=0.001, respectively).
SCPL should be conducted only after a thorough pre-operative evaluation in locally advanced laryngeal cancer. Additionally, adjuvant treatment is necessary to reduce local recurrence in cases where thyroid cartilage invasion is determined pathologically after SCPL.
本研究旨在评估术前T分期过低对环状软骨上部分喉切除术（SCPL）临床结局的影响。
对92例行SCPL患者的病历进行评估。通过比较临床和病理分期，研究术前T分期过低的原因及其与局部复发和生存的关系。
15例患者（16.3%）术前T分期过低，主要原因是未识别出甲状腺软骨受侵（11例）。其中，仅2例患者接受了原发部位的放疗，包括1例手术切缘阳性的患者。在82例随访超过1年的患者中，7例（8.5%）出现局部复发；其中5例（71.4%）术前分期过低是由于未检测到甲状腺软骨受侵。与术前分期准确的患者相比，术前分期过低的患者局部复发率更高，总生存率更低（分别为p=0.006和p=0.001）。
对于局部晚期喉癌，应在进行全面的术前评估后再行SCPL。此外，对于SCPL术后病理确定有甲状腺软骨受侵的病例，有必要进行辅助治疗以降低局部复发。
