Issa Mohamad R, Samuels Stuart E, Bellile Emily, Shalabi Firas L, Eisbruch Avraham, Wolf Gregory
Department of Otolaryngology/Head and Neck Surgery, The University of Michigan Health System, 1903 Taubman Bldg, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
Department of Radiation Oncology, The University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
Cancers (Basel). 2015 Nov 10;7(4):2236-61. doi: 10.3390/cancers7040888.
Tumor staging systems for laryngeal cancer (LC) have been developed to assist in estimating prognosis after treatment and comparing treatment results across institutions. While the laryngeal TNM system has been shown to have prognostic information, varying cure rates in the literature have suggested concern about the accuracy and effectiveness of the T-classification in particular. To test the hypothesis that tumor volumes are more useful than T classification, we conducted a retrospective review of 78 patients with laryngeal cancer treated with radiation therapy at our institution. Using multivariable analysis, we demonstrate the significant prognostic value of anatomic volumes in patients with previously untreated laryngeal cancer. In this cohort, primary tumor volume (GTVP), composite nodal volumes (GTVN) and composite total volume (GTVP + GTVN = GTVC) had prognostic value in both univariate and multivariate cox model analysis. Interestingly, when anatomic volumes were measured from CT scans after a single cycle of induction chemotherapy, all significant prognosticating value for measured anatomic volumes was lost. Given the literature findings and the results of this study, the authors advocate the use of tumor anatomic volumes calculated from pretreatment scans to supplement the TNM staging system in subjects with untreated laryngeal cancer. The study found that tumor volume assessment after induction chemotherapy is not of prognostic significance.
喉癌（LC）的肿瘤分期系统已被开发出来，以帮助评估治疗后的预后情况，并比较各机构的治疗结果。虽然喉癌TNM系统已被证明具有预后信息，但文献中不同的治愈率表明，人们尤其关注T分类的准确性和有效性。为了检验肿瘤体积比T分类更有用这一假设，我们对我院78例接受放射治疗的喉癌患者进行了回顾性研究。通过多变量分析，我们证明了解剖体积对未经治疗的喉癌患者具有显著的预后价值。在这个队列中，原发肿瘤体积（GTVP）、复合淋巴结体积（GTVN）和复合总体积（GTVP + GTVN = GTVC）在单变量和多变量Cox模型分析中均具有预后价值。有趣的是，当在诱导化疗的单个周期后从CT扫描测量解剖体积时，测量的解剖体积的所有显著预后价值都丧失了。鉴于文献研究结果和本研究结果，作者主张在未经治疗的喉癌患者中，使用根据治疗前扫描计算出的肿瘤解剖体积来补充TNM分期系统。研究发现，诱导化疗后的肿瘤体积评估不具有预后意义。
