阐明挽救性喉切除术的病理和临床变量，以指导进一步的强化治疗研究。

Elucidation of salvage laryngectomy pathologic and clinical variables to guide further treatment intensification investigation.

作者信息

Scharpf Joseph, Ward Matthew, Adelstein David, Koyfman Shlomo, Li Mingsi

机构信息

Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.

Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.

出版信息

Laryngoscope. 2018 Apr;128(4):823-830. doi: 10.1002/lary.26782. Epub 2017 Sep 11.

DOI:10.1002/lary.26782

PMID:28891087

Abstract

OBJECTIVE/HYPOTHESIS: There are limited treatment options beyond surgical salvage for patients who fail nonoperative treatment for laryngeal squamous cell carcinoma. In this study, we examine the failure patterns after surgical salvage and the potential pathologic and clinical prognostic variables that might guide further postoperative intensification investigation.

STUDY DESIGN

Retrospective analysis at a tertiary academic referral center.

METHODS

From an institutional review board-approved institutional head and neck cancer registry, a consecutive series of 147 patients who underwent salvage laryngectomy for squamous cell cancer recurrence or persistence after radiotherapy with or without chemotherapy between May 1995 and May 2016 were identified. Variables potentially associated with oncologic outcome after surgical salvage were then collected and retrospectively evaluated.

RESULTS

The projected 2-year locoregional failure rate was 21.8% (95% confidence interval [CI], 14.6%-29.0%]), and the overall survival 65% (95% CI, 57.5%-74.3%) for the entire cohort after salvage laryngectomy. On multivariable analysis, sarcomatoid/spindle cell pathology (hazard ratio [HR], 3.147; 95% CI, 1.181-8.386; P = 0.022), lymphovascular space invasion (LVSI) (positive vs. negative; HR, 2.31; 95% CI, 1.21-4.42; P = 0.011), and advanced initial American Joint Committee on Cancer 7th Edition grouped stage (stages III-IVB vs. stages I-II; HR, 1.64; 95% CI, 1.04-2.6; P = 0.035) were found to be independently associated with inferior disease-free survival. No other clinical or pathologic variables predicted failure.

CONCLUSION

Salvage laryngectomy after nonoperative treatment failure results in successful locoregional control rates and survival in the majority of patients failing initial therapy. This should temper enthusiasm for routine treatment intensification with postoperative re-irradiation and/or other systemic treatments for the vast majority of patients. Sarcomatoid pathology, LVSI, and an advanced initial stage are associated with inferior disease-free survival. The presence of these factors may warrant further investigational study of treatment intensification after salvage laryngectomy.

LEVEL OF EVIDENCE

Laryngoscope, 128:823-830, 2018.

摘要

目的/假设：对于喉鳞状细胞癌非手术治疗失败的患者，除手术挽救外，治疗选择有限。在本研究中，我们研究了手术挽救后的失败模式以及可能指导进一步术后强化治疗研究的潜在病理和临床预后变量。

研究设计

在一家三级学术转诊中心进行回顾性分析。

方法

从机构审查委员会批准的机构头颈癌登记处，确定了1995年5月至2016年5月期间因放疗联合或不联合化疗后鳞状细胞癌复发或持续而接受挽救性喉切除术的连续147例患者。然后收集并回顾性评估与手术挽救后肿瘤学结局潜在相关的变量。

结果

整个队列在挽救性喉切除术后预计的2年局部区域失败率为21.8%（95%置信区间[CI]，14.6%-29.0%），总生存率为65%（95%CI，57.5%-74.3%）。多变量分析显示，肉瘤样/梭形细胞病理（风险比[HR]，3.147；95%CI，1.181-8.386；P = 0.022）、脉管侵犯（LVSI）（阳性与阴性；HR，2.31；95%CI，1.21-4.42；P = 0.011）以及美国癌症联合委员会第7版初始分期较晚（III-IVB期与I-II期；HR，1.64；95%CI，1.04-2.6；P = 0.035）被发现与无病生存期较差独立相关。没有其他临床或病理变量可预测失败。