Markou K, Goudakos J, Triaridis S, Konstantinidis J, Vital V, Nikolaou A
1 Department of Otorhinolangology, AHEPA University Hospital, Thessaloniki, Greece.
Hippokratia. 2011 Jan;15(1):75-80.
The loco-regional recurrence of laryngeal carcinoma in patients who underwent total laryngectomy is related to numerous factors. Aim of the present study was to investigate the role of patient's age and tumor size in the recurrence rate of patients. Additional aim of the current study was to investigate the possible associations between the size of the tumor and other characteristics.
In 1st Department of Otorhinolaryngology of AHEPA University Hospital, from 1992 to 2007, 255 patients with laryngeal carcinoma underwent total laryngectomy. Accurate data regarding the size of the tumor were obtained. Total laryngectomy was the initial treatment in 212 patients, while in the remaining 43 patients was performed as salvage surgery after recurrence.
The median tumor size was 2.74 cm (0.8-5.5 cm). There was no significant difference in the median tumor size between the patients who had recurrence (2.87 cm) and the disease free patients (2.69 cm). The median size of glottic tumors (2.47 cm) was smaller than that of supraglottic (2.95 cm) and of subglottic tumors (3.27 cm) (p<0.05). Among the 255 patients, recurrence of the tumor occurred in 73 (28.7%). Statistical analysis of the data showed that the tumor size was affecting the recurrence rate in a different manner, according the stage of the tumor. The recurrence rate in T3 neoplasms was higher in larger tumors than in smaller (13.2% for tumors<2cm, 62% for tumors>4cm), while T4 carcinomas appeared to have the opposite behavior (66.5% for tumors <2cm, 23% for tumors >4cm). The median tumor size in T4 patients that recurred was smaller than in those with no recurrence (2.8 cm Vs 3.3 cm). This behavior was observed in T4 tumors from all sites. Patients who experienced recurrence and had positive neck lymph nodes at the time of the initial diagnosis appeared to have smaller laryngeal tumors (2.7 cm), compared to with the same group of patients with no recurrence (3.5 cm). Supraglottic location and advanced T stage showed a statistically significant impact on disease free survival, based on Cox regression model.
Smaller sized tumors in patients with locally advanced laryngeal cancer (T4) or regionally (N+) appear to have more aggressive behavior and higher recurrence rate. Thus, the small tumor size could be regarded as an unfavorable prognostic factor for those laryngeal cancer cases.
接受全喉切除术的喉癌患者局部区域复发与多种因素相关。本研究的目的是调查患者年龄和肿瘤大小对患者复发率的作用。本研究的另一目的是调查肿瘤大小与其他特征之间可能存在的关联。
在阿赫帕大学医院耳鼻喉科第一科室，1992年至2007年期间，255例喉癌患者接受了全喉切除术。获取了关于肿瘤大小的准确数据。212例患者将全喉切除术作为初始治疗，而其余43例患者在复发后进行挽救性手术。
肿瘤大小中位数为2.74厘米（0.8 - 5.5厘米）。复发患者（2.87厘米）与无疾病患者（2.69厘米）的肿瘤大小中位数无显著差异。声门区肿瘤的大小中位数（2.4,7厘米）小于声门上区（2.95厘米）和声门下区肿瘤（3.27厘米）（p<0.05）。在这255例患者中，73例（28.7%）出现肿瘤复发。对数据的统计分析表明，根据肿瘤分期，肿瘤大小对复发率的影响方式不同。T3期肿瘤中，较大肿瘤的复发率高于较小肿瘤（肿瘤<2厘米者为13.2%，肿瘤>4厘米者为62%），而T4期癌表现出相反的情况（肿瘤<2厘米者为66.5%，肿瘤>4厘米者为23%）。复发的T4期患者的肿瘤大小中位数小于未复发患者（2.8厘米对vs,3.3厘米）。在所有部位的T4期肿瘤中均观察到这种情况。与初始诊断时颈部淋巴结无转移且未复发的同一组患者相比，初始诊断时颈部淋巴结转移且复发的患者喉肿瘤似乎较小（2.7厘米）。基于Cox回归模型分析，声门上区位置和T分期进展对无病生存期有统计学显著影响。
局部晚期喉癌（T4）或区域转移（N+）患者中较小的肿瘤似乎具有更侵袭性的行为和更高的复发率。因此，对于那些喉癌病例，小肿瘤大小可被视为一个不利的预后因素。
