Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Otolaryngology, Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2017 Jul;80(7):452-457. doi: 10.1016/j.jcma.2017.04.002. Epub 2017 Jun 3.
Transoral laser microsurgery (TLM) is used to treat early and select cases of moderately advanced glottic cancer, with results equivalent to those of conventional conservative surgery and radiotherapy (RT). As surgeons and researchers become more experienced and familiar with TLM, they can focus on mechanisms to earlier detect local recurrence, to more effectively preserve laryngeal function. This study analyzed the predictors of local recurrence in glottic cancer patients who underwent TLM.
Our study focused on 93 consecutive patients with glottic cancer who received TLM between 2003 and 2009, and were analyzed retrospectively. All of these patients were treated by the same surgeon. The local control and survival rate were calculated with Kaplan-Meier method and compared using the log-rank test. Additionally, the Cox proportional hazard model was used for multivariate analysis.
The 5-year local control, overall survival, and disease-specific survival rates were 87%, 95%, and 96%, respectively. The final laryngeal preservation rate was 98%. Independent predictors of local recurrence were arytenoid cartilage invasion (hazard ratio [HR], 6.5; 95% confidence interval [CI], 2.1-26.6), difficult laryngeal exposure (HR, 4.6; 95% CI, 1.5-17.3), previous microlaryngoscopic surgery (HR 3.1; 95% CI, 1.3-10.5), positive surgical margin (HR, 2.7; 95% CI, 1.1-9.7), and endophytic tumors (HR, 2.6; 95% CI, 1.1-7.6).
TLM is a reliable modality to treat early and select cases of moderately advanced glottic cancer with good final laryngeal preservation rate. Our study found that independent factors of local recurrence included arytenoid cartilage invasion, difficult laryngeal exposure, previous microlaryngoscopic surgery, positive surgical margin and endophytic tumors. These findings may help to follow-up glottic cancer patients after TLM.
经口激光显微手术（TLM）用于治疗早期和选择的中晚期声门型癌症病例，其结果与传统的保守手术和放射治疗（RT）相当。随着外科医生和研究人员对 TLM 的经验和熟悉程度的提高，他们可以专注于更早地发现局部复发的机制，更有效地保留喉功能。本研究分析了接受 TLM 的声门型癌症患者局部复发的预测因素。
我们的研究集中在 2003 年至 2009 年间接受 TLM 的 93 例连续声门型癌症患者，进行回顾性分析。所有患者均由同一位外科医生治疗。通过 Kaplan-Meier 方法计算局部控制和生存率，并通过对数秩检验进行比较。此外，还使用 Cox 比例风险模型进行多变量分析。
5 年局部控制、总生存率和疾病特异性生存率分别为 87%、95%和 96%。最终的喉保留率为 98%。局部复发的独立预测因素包括杓状软骨侵犯（风险比[HR]，6.5；95%置信区间[CI]，2.1-26.6）、喉暴露困难（HR，4.6；95%CI，1.5-17.3）、先前的显微喉镜手术（HR，3.1；95%CI，1.3-10.5）、阳性手术切缘（HR，2.7；95%CI，1.1-9.7）和内生型肿瘤（HR，2.6；95%CI，1.1-7.6）。
TLM 是一种可靠的治疗早期和选择的中晚期声门型癌症的方法，具有良好的最终喉保留率。我们的研究发现，局部复发的独立因素包括杓状软骨侵犯、喉暴露困难、先前的显微喉镜手术、阳性手术切缘和内生型肿瘤。这些发现可能有助于 TLM 后对声门型癌症患者进行随访。
