Leszczyńska Małgorzata, Tokarski Maciej, Jarmołowska-Jurczyszyn Donata, Kosikowski Paweł, Szyfter Witold, Wierzbicka Małgorzata
Department of Otolaryngology, Head and Neck Surgery, Poznań University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznań, Poland,
Eur Arch Otorhinolaryngol. 2015 Aug;272(8):1973-81. doi: 10.1007/s00405-015-3594-9. Epub 2015 Mar 21.
Open partial horizontal laryngectomy (OPHL) specimens include cartilage and lymph nodes. Pathological adverse findings (PAF): perichondrium, cartilage, perineural invasion, microvessel spread and prelaryngeal metastases can be detected histologically. We aimed at examining PAF in OPHL specimens and examining the interdependence with oncological outcomes. Prospective analysis of 254 glottis cancers: 87-T2a, 77-T2b and 90-T3 with anterior commissure (AC) involvement treated by OPHL at tertiary referral centre between 2001 and 2008. In 38/254 patients (15 %) PAF were found (16 prelaryngeal metastases, 22 other); more often in stage T2b/T3 versus T2a (p = 0.008). PAF other than prelaryngeal metastases were found more often in T2b than T2a tumours (p = 0.005). Outcomes revealed that out of 36 patients with local recurrence, 19 had PAF. Comparison of 216 patients with no PAF and 16 patients with prelaryngeal metastases revealed, respectively: 7.9 versus 81.3 % local recurrences (p = 0.034), 3.2 versus 68.8 % nodal recurrences (p = 0.011), 90.7 versus 43.8 % of 5-year organ preservation (p = 0.021) and 92.6 versus 75 % 5-year overall survival (p = 0.022). Out of 10 patients with close margins, 1 developed the local recurrence; impact for organ preservation and overall survival was not significant. In 22/254 cases including the cartilage into the operating specimen were therapeutically meaningful; in 16/254 with prelaryngeal metastases, the impact for larynx preservation and overall survival was significant. T2b patients had higher probability of PAF than T2a. PAF significantly influenced higher local recurrence rate. This finding ensures the authors, that OPHL type II is not the "overtreatment" compared to the TLM.
开放性部分水平喉切除术（OPHL）标本包括软骨和淋巴结。病理不良发现（PAF）：软骨膜、软骨、神经周围浸润、微血管扩散和喉前转移可通过组织学检测到。我们旨在检查OPHL标本中的PAF，并检查其与肿瘤学结果的相互关系。对254例声门癌进行前瞻性分析：2001年至2008年在三级转诊中心接受OPHL治疗的87例T2a、77例T2b和90例伴有前联合（AC）受累的T3患者。在254例患者中的38例（15%）发现了PAF（16例喉前转移，22例其他）；在T2b/T3期比T2a期更常见（p = 0.008）。除喉前转移外的PAF在T2b期肿瘤中比T2a期更常见（p = 0.005）。结果显示，在36例局部复发患者中，19例有PAF。对216例无PAF患者和16例有喉前转移患者的比较分别显示：局部复发率为7.9%对81.3%（p = 0.034），淋巴结复发率为3.2%对68.8%（p = 0.011），5年器官保留率为90.7%对43.8%（p = 0.021），5年总生存率为92.6%对75%（p = 0.022）。在10例手术切缘接近的患者中，1例发生局部复发；对器官保留和总生存率的影响不显著。在254例病例中的22例将软骨纳入手术标本具有治疗意义；在16例有喉前转移的病例中，对喉保留和总生存率的影响显著。T2b患者发生PAF的概率高于T2a。PAF显著影响更高的局部复发率。这一发现使作者确信，与喉激光显微手术（TLM）相比，II型OPHL并非“过度治疗”。
