Saint Louis University School of Medicine, St. Louis, MO, USA.
Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA; Saint Louis University Cancer Center, St. Louis, MO, USA.
Oral Oncol. 2019 Oct;97:105-111. doi: 10.1016/j.oraloncology.2019.08.005. Epub 2019 Aug 29.
The impact of positive tumor margin status and other clinicopathological factors on prognosis in early stage glottic squamous cell carcinoma (SCC) treated with transoral laser microsurgery (TLM) remains unclear. This study examined overall survival (OS) rates of patients with positive tumor margin status compared to negative tumor margin status after TLM in clinical T1-2 glottic SCC.
The National Cancer Data Base (NCDB) was queried for patients who underwent resection of T1-2 glottic SCC by TLM. Patients were treated from 2004 to 2013. Overall survival was assessed with Kaplan-Meier curve analysis, and univariate and multivariate Cox proportional hazards analysis. Differences in clinicopathologic factors between positive and negative margin groups were compared using Pearson Chi-squared analysis.
Of 747 patients meeting inclusion criteria, 598 (80.1%) had negative margins. Median follow-up time was 48.0 months. Unadjusted 5-year OS for positive margins (80.0%) was lower compared to that of negative tumor margins (82.9%), but this was not statistically significant (P = 0.265). This persisted after multivariate analysis (P = 0.960). When tumors were stratified by T stage (647 T1, 100 T2), unadjusted 5-year OS based on margin status remained statistically insignificant for both T1 (P = 0.933) and T2 tumors (P = 0.350).
Positive margins did not negatively impact overall survival among patients with TLM-treated early-stage glottic cancer. This finding might be useful clinically in deciding treatment modality for early stage glottic SCC.
经口激光微创手术（TLM）治疗早期声门型鳞状细胞癌（SCC）中，阳性肿瘤切缘状态和其他临床病理因素对预后的影响尚不清楚。本研究检查了 TLM 治疗后 T1-2 声门型 SCC 中阳性肿瘤切缘状态患者与阴性肿瘤切缘状态患者的总生存率（OS）。
从国家癌症数据库（NCDB）中查询了经 TLM 切除 T1-2 声门型 SCC 的患者。患者于 2004 年至 2013 年接受治疗。采用 Kaplan-Meier 曲线分析、单因素和多因素 Cox 比例风险分析评估总生存率。采用 Pearson Chi-squared 分析比较阳性和阴性切缘组之间的临床病理因素差异。
符合纳入标准的 747 例患者中，598 例（80.1%）为阴性切缘。中位随访时间为 48.0 个月。阳性切缘的未调整 5 年 OS（80.0%）低于阴性肿瘤切缘（82.9%），但无统计学意义（P=0.265）。多因素分析后仍如此（P=0.960）。当按 T 分期（647 例 T1，100 例 T2）对肿瘤进行分层时，基于切缘状态的未调整 5 年 OS 对于 T1（P=0.933）和 T2 肿瘤（P=0.350）均无统计学意义。
TLM 治疗早期声门型癌症患者的阳性切缘并未对总生存率产生负面影响。这一发现对于决定早期声门型 SCC 的治疗方式可能具有临床意义。
