喉保留治疗失败患者行挽救性手术时隐匿性淋巴结转移。
Occult nodal disease in patients with failed laryngeal preservation undergoing surgical salvage.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, U.S.A.
出版信息
Laryngoscope. 2014 Feb;124(2):421-8. doi: 10.1002/lary.24005. Epub 2013 Dec 9.
OBJECTIVES/HYPOTHESIS: The primary objective was to determine the incidence of pathologically positive lymph nodes in clinically N0 larynx cancer patients undergoing salvage surgery following nonsurgical primary therapy. Secondary aims included assessment of the impact of laryngeal subsite and neck dissection on disease status and survival.
STUDY DESIGN
Retrospective chart review.
METHODS
Sixty-eight patients with recurrent laryngeal cancer and no evidence of neck disease who underwent salvage laryngectomy and neck dissection after undergoing failed primary radiotherapy or chemoradiation were examined. Main outcome measures included: standard demographics, primary, clinical, radiologic, and pathologic recurrent TNM stage, laryngeal subsite, nodal neck level, surgical intervention, margin status, disease status, survival, and imaging results.
RESULTS
Fifty-three men and 15 women, aged 33 to 88 years (mean=62.7 years) with recurrent laryngeal cancer were included. Overall, 28.3% of patients had pathologic nodal disease, with supraglottic cancer showing the highest rate (60%, P=.02). Survival was not associated with laryngectomy type (P=.35). However, on multivariate analysis, laryngeal subsite was significantly predictive of survival with transglottic recurrences demonstrating decreased mean survival (20.7 months, P=.02), and supraglottic recurrences demonstrating prolonged mean survival (37.1 months, P=.03). Metabolic imaging (negative predictive value=0.86) proved more reliable than anatomic imaging (negative predictive value=0.71).
CONCLUSIONS
The incidence of pathologically positive lymph nodes in clinically negative patients with recurrent laryngeal carcinoma following nonsurgical therapy warrants standard selective neck dissection. Subsite of recurrence, specifically supraglottis and transglottis, correlates with pathologic neck node positivity and survival. Metabolic imaging proved more reliable than anatomic imaging in negative predictability for nodal disease.
LEVEL OF EVIDENCE
目的/假设：主要目的是确定接受非手术原发治疗后行挽救性手术的临床 N0 喉癌患者中病理性阳性淋巴结的发生率。次要目的包括评估喉亚部位和颈部解剖对疾病状态和生存的影响。
研究设计
回顾性图表审查。
方法
检查了 68 例接受挽救性喉切除术和颈淋巴结清扫术的复发性喉癌且无颈部疾病证据的患者，这些患者在经历失败的原发性放疗或放化疗后复发。主要观察指标包括：标准人口统计学资料、原发、临床、影像学和病理复发 TNM 分期、喉亚部位、淋巴结颈部水平、手术干预、切缘状态、疾病状态、生存和影像学结果。
结果
共纳入 53 名男性和 15 名女性，年龄 33 至 88 岁（平均 62.7 岁），患有复发性喉癌。总体而言，28.3%的患者存在病理性淋巴结疾病，其中声门上型癌症的发生率最高（60%，P=.02）。生存与喉切除术类型无关（P=.35）。然而，多变量分析显示，喉亚部位与生存显著相关，声门型复发的平均生存时间较短（20.7 个月，P=.02），声门上型复发的平均生存时间较长（37.1 个月，P=.03）。代谢成像（阴性预测值=0.86）比解剖成像（阴性预测值=0.71）更可靠。
结论
非手术治疗后临床阴性复发性喉癌患者的病理性阳性淋巴结发生率需要行标准的选择性颈部清扫术。复发的亚部位，特别是声门上型和声门型，与病理性颈部淋巴结阳性和生存相关。代谢成像在预测淋巴结疾病的阴性预测值方面比解剖成像更可靠。
证据水平
4 级。
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