Elicin Olgun, Ermiş Ekin, Oehler Christoph, Aebersold Daniel M, Caparrotti Francesca, Zimmermann Frank, Studer Gabriela, Henke Guido, Adam Lukas, Anschuetz Lukas, Ozsahin Mahmut, Guckenberger Matthias, Shelan Mohamed, Kaydıhan Nuri, Riesterer Oliver, Prestwich Robin J D, Spielmann Thierry, Giger Roland, Şen Mehmet
Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom.
Front Oncol. 2019 Sep 20;9:932. doi: 10.3389/fonc.2019.00932. eCollection 2019.
Larynx cancer represents one of the most frequently diagnosed head and neck malignancies, which is most often confined to the glottic area. The aim of this study was to report the oncological outcome and identify prognostic factors in early-stage glottic squamous cell carcinoma treated with radiotherapy. Patients ( = 761) diagnosed and treated in 10 centers between 1990 and 2015 were retrospectively analyzed. Probabilities of loco-regional control (LRC) and overall survival (OS) were calculated and possible prognostic factors were analyzed using Cox proportional hazards models. The median follow-up was 63 months (range: 2-243). Three hundred and sixty-four, 148 and 249 patients had cT1a, cT1b, and cT2 stage I-II disease, respectively. Five and 10-years LRC/OS rates in the whole cohort were 83/82% and 80/68%, respectively. Three patients developed distant recurrences. In univariate analysis, male sex (HR: 3.49; 95% CI: 1.47-11.37; < 0.01), T2 vs. T1a (HR: 1.62; 95% CI: 1.08-2.43; = 0.02) and anterior commissure involvement (ACI) (HR: 1.66; 95% CI: 1.38-2.45; < 0.01) were associated with impaired LRC. In multivariate analysis, male sex (HR: 3.42; 95% CI: 1.44-11.17; < 0.01) and ACI (HR: 1.51; 95% CI: 1.01-2.28; = 0.047) remained poor prognostic factors. No relation of treatment technique and biologically equivalent dose (BED) to oncological outcome was identified except for higher BED(L = 25; T = 1) yielding better LRC in T1a tumors ( = 0.04) in univariate analyses. Our results highlight the negative impact of ACI on tumor control. A less-expected finding was the impact of sex on tumor control. Further research is needed to validate its prognostic value and investigate any related biologic or behavioral factors, which may be modified to improve oncologic outcome.
喉癌是最常被诊断出的头颈部恶性肿瘤之一，最常局限于声门区。本研究的目的是报告早期声门鳞状细胞癌接受放射治疗后的肿瘤学结果，并确定预后因素。对1990年至2015年间在10个中心诊断和治疗的761例患者进行了回顾性分析。计算局部区域控制（LRC）和总生存期（OS）的概率，并使用Cox比例风险模型分析可能的预后因素。中位随访时间为63个月（范围：2 - 243个月）。分别有364例、148例和249例患者患有cT1a、cT1b和cT2期I-II疾病。整个队列的5年和10年LRC/OS率分别为83/82%和80/68%。3例患者出现远处复发。在单因素分析中，男性（HR：3.49；95%CI：1.47 - 11.37；P < 0.01）、T2与T1a相比（HR：1.62；95%CI：1.08 - 2.43；P = 0.02）以及前联合受累（ACI）（HR：1.66；95%CI：1.38 - 2.45；P < 0.01）与LRC受损相关。在多因素分析中，男性（HR：3.42；95%CI：1.44 - 11.17；P < 0.01）和ACI（HR：1.51；95%CI：1.01 - 2.28；P = 0.047）仍然是不良预后因素。除了在单因素分析中较高的生物等效剂量（BED）（L = 25；T = 1）在T1a肿瘤中产生更好的LRC（P = 0.04）外，未发现治疗技术和BED与肿瘤学结果之间的关系。我们的结果突出了ACI对肿瘤控制的负面影响。一个不太预期的发现是性别对肿瘤控制的影响。需要进一步研究以验证其预后价值，并研究任何相关的生物学或行为因素，这些因素可能被改变以改善肿瘤学结果。
