Marchi Filippo, Piazza Cesare, Ravanelli Marco, Gaggero Giovanna, Parrinello Giampiero, Paderno Alberto, Perotti Pietro, Filauro Marta, Maroldi Roberto, Peretti Giorgio
Department of Otorhinolaryngology, Head and Neck Surgery, University of Genoa, Genoa, Italy.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Brescia, Spedali Civili of Brescia, Piazza Spedali Civili 1, 25123, Brescia, Italy.
Eur Arch Otorhinolaryngol. 2017 Oct;274(10):3679-3686. doi: 10.1007/s00405-017-4642-4. Epub 2017 Jun 19.
An unblinded retrospective analysis of prospectively collected data was carried out on 138 patients affected by glottic pT2 and selected pT3 squamous cell carcinomas (SCC) treated by transoral laser microsurgery (TLM). The entire cohort was divided into two groups: Group A included 78 "high-risk" patients (pT2 with impaired vocal cord mobility, pT3 for anterior paraglottic and/or pre-epiglottic space invasion, presence of angioembolization, perineural spread, and positive lymph nodes in the neck) who underwent postoperative surveillance by endoscopy and imaging (CT or MR), while Group B included 60 "low-risk" patients (pT2 with absence of the above-mentioned features) who underwent endoscopic follow-up alone. Aim of the present study was to assess the diagnostic gain in performing combined endoscopic and radiologic surveillance in the "high-risk" group compared to endoscopy alone in the "low-risk" one. There was no significant difference in terms of overall and disease-specific survivals between the two follow-up policies in spite of their different risk profiles. The same was true for organ preservation rate, which was 81% in the "high-risk" and 89% in the "low-risk" group. In contrast, the cumulative probability of disease-free survival was 54% for Group A and 65% for Group B (p = 0.0023). Therefore, our combined endoscopy and imaging surveillance protocol allowed increasing the submucosal recurrence detection rate in "high-risk" pT2-pT3 glottic SCC to 43%. An earlier detection of submucosal recurrences made salvage surgery by TLM feasible in at least half of cases, thus closing the gap between oncologic outcomes obtained in "high-"- vs. "low-risk" patients and leading to organ preservation rates that are favorably comparable to those obtained with open-neck partial laryngectomies and non-surgical organ preservation protocols.
对138例声门型pT2和部分选定的pT3鳞状细胞癌（SCC）患者进行了一项非盲法回顾性分析，这些患者均接受了经口激光显微手术（TLM）治疗，数据为前瞻性收集。整个队列分为两组：A组包括78例“高危”患者（声门型pT2伴声带活动受限、pT3伴声门前间隙和/或会厌前间隙受侵、存在血管栓塞、神经周围浸润以及颈部淋巴结阳性），术后接受内镜检查和影像学检查（CT或MR）进行监测；而B组包括60例“低危”患者（声门型pT2且无上述特征），仅接受内镜随访。本研究的目的是评估“高危”组联合内镜和放射学监测相对于“低危”组单纯内镜监测的诊断获益。尽管两组的风险特征不同，但两种随访策略在总生存率和疾病特异性生存率方面无显著差异。器官保留率也是如此，“高危”组为81%，“低危”组为89%。相比之下，A组无病生存率的累积概率为54%，B组为65%（p = 0.0023）。因此，我们的联合内镜和影像学监测方案使“高危”声门型pT2 - pT3 SCC的黏膜下复发检出率提高到了43%。黏膜下复发的早期检测使得至少一半的病例可行TLM挽救性手术，从而缩小了“高危”与“低危”患者在肿瘤学结局方面的差距，并使器官保留率与开放性颈部分喉切除术和非手术器官保留方案所获得的结果相当。
