Brandstorp-Boesen Jesper, Sørum Falk Ragnhild, Boysen Morten, Brøndbo Kjell
University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway.
Department of Otorhinolaryngology, Division of Surgery and Clinical Neuroscience, Oslo University Hospital, Oslo, Norway.
PLoS One. 2017 Jul 14;12(7):e0179371. doi: 10.1371/journal.pone.0179371. eCollection 2017.
A retrospective, longitudinal study of 1,616 patients with primary laryngeal squamous cell carcinoma (LSCC) at a single center in Norway during 1983-2010 was undertaken to investigate overall survival, disease specific survival, disease-free survival, prognostic factors for overall survival, and impact of recurrence among all-stage laryngeal cancer patients over 15 years' follow-up. The prognostic impact of gender, age, smoking/alcohol, subsite, tumour, node and metastasis staging, period and modality of treatment were evaluated using Kaplan-Meier and Cox proportional hazard analyses. The importance of recurrence on survival was assessed based on case fatality rates. Five-year overall survival was 56.8%, 64.0% and 38.8%, and disease-specific survival was 80.2%, 87% and 61.6%, respectively, for the entire cohort and for glottic and supraglottic LSCC. Old age, advanced-stage LSCC and supraglottic cancer were associated with lower overall survival. The risk of disease-specific death plateaued after five years and varied significantly by subsite. Multivariate analysis of glottic LSCC revealed that surgical treatment improved overall survival, whereas old age, alcohol, T3-T4 status, positive N-status and no treatment were associated with worse survival. In supraglottic LSCC, age, alcohol, and positive N-status had a significant impact on overall survival by multivariate analysis. Five-year overall survival and disease-specific survival among patients with recurrent disease were 34% and 52%, respectively. In conclusion, marked difference in overall survival between glottic and supraglottic LSCC underline the importance of subsite-specific survival analysis. T-status and primary surgical management is essential only for glottic LSCC, emphasizing the importance of correct disease classification. Inferior outcomes in supraglottic LSCC are associated with old age, positive N-status, and improved follow-up routines are necessary. Primary tumor control is essential since recurrence impairs survival considerably in all subsites. The potential benefit of a primary surgical approach towards T3 LSCC awaits further investigation.
对1983年至2010年期间挪威单中心的1616例原发性喉鳞状细胞癌(LSCC)患者进行了一项回顾性纵向研究,以调查15年随访期间所有阶段喉癌患者的总生存期、疾病特异性生存期、无病生存期、总生存期的预后因素以及复发的影响。使用Kaplan-Meier和Cox比例风险分析评估性别、年龄、吸烟/饮酒、亚部位、肿瘤、淋巴结和转移分期、治疗时期和方式的预后影响。根据病死率评估复发对生存的重要性。整个队列以及声门型和声门上型LSCC的五年总生存率分别为56.8%、64.0%和38.8%,疾病特异性生存率分别为80.2%、87%和61.6%。老年、晚期LSCC和声门上型癌与较低的总生存率相关。疾病特异性死亡风险在五年后趋于平稳,且因亚部位而异。声门型LSCC的多因素分析显示,手术治疗可提高总生存率,而老年、饮酒、T3-T4状态、N阳性状态和未治疗与较差的生存率相关。在声门上型LSCC中,多因素分析显示年龄、饮酒和N阳性状态对总生存率有显著影响。复发患者的五年总生存率和疾病特异性生存率分别为34%和52%。总之,声门型和声门上型LSCC在总生存率上的显著差异突显了亚部位特异性生存分析的重要性。T分期和初次手术管理仅对声门型LSCC至关重要,强调了正确疾病分类的重要性。声门上型LSCC的不良预后与老年、N阳性状态相关,因此有必要改进随访程序。原发性肿瘤控制至关重要,因为复发会严重影响所有亚部位的生存。对于T3 LSCC采用初次手术方法的潜在益处有待进一步研究。