喉和下咽鳞状细胞癌挽救性喉切除术的肿瘤学结果：一项多中心回顾性队列研究。

Oncologic Outcomes After Salvage Laryngectomy for Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study.

机构信息

Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium.

Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium.

出版信息

Ann Surg Oncol. 2021 Mar;28(3):1751-1761. doi: 10.1245/s10434-020-09017-0. Epub 2020 Aug 28.

DOI:10.1245/s10434-020-09017-0

PMID:32860174

Abstract

OBJECTIVE

We aimed to analyze oncologic outcomes and identify patterns of failure and negative prognostic factors in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx.

METHODS

This was a retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018 for residual/recurrent/second primary SCC in the larynx or hypopharynx after initial (chemo)radiation. Prognostic factors for oncologic outcomes were identified using univariable and multivariable analysis.

RESULTS

A total of 405 patients were included in the final analysis. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional relapse-free survival (LRFS) estimates were 47.7% (95% confidence interval [CI] 42.0-53.2%), 68.7% (95% CI 63.7-73.7%), 42.1% (95% CI 36.7-47.4%), and 44.3% (95% CI 38.8-49.7%), respectively. In a multivariable model, increasing clinical tumor stage of the residual/recurrent/second primary tumor, increasing number of metastatic cervical lymph nodes retrieved during neck dissection, hypopharyngeal and supraglottic tumor location, positive section margin status and perineural invasion were independent negative prognostic variables for OS, DSS, DFS, and LRFS. The type of second tumor was identified as an additional independent prognosticator for DSS, with local recurrences and second primary tumors having a better prognosis than residual tumor.

CONCLUSIONS AND RELEVANCE

Favorable oncologic outcomes are reported after STL. Increasing clinical tumor stage, increasing number of metastatic cervical lymph nodes, hypopharyngeal and supraglottic tumor location, positive section margins, and perineural invasion are identified as independent negative prognosticators for all oncologic outcome measures.

摘要

目的

我们旨在分析接受挽救性全喉切除术（STL）治疗喉和下咽残留、复发性和第二原发性鳞状细胞癌（SCC）患者的肿瘤学结果，并确定失败模式和负性预后因素。

方法

这是一项回顾性队列研究，纳入了 2002 年至 2018 年期间在比利时四家主要参考医院接受 STL 治疗的患者，这些患者在初始（放）化疗后喉或下咽残留/复发性/第二原发性 SCC。使用单变量和多变量分析确定肿瘤学结果的预后因素。

结果

最终分析共纳入 405 例患者。5 年总生存率（OS）、疾病特异性生存率（DSS）、无病生存率（DFS）和局部区域无复发生存率（LRFS）估计值分别为 47.7%（95%CI 42.0-53.2%）、68.7%（95%CI 63.7-73.7%）、42.1%（95%CI 36.7-47.4%）和 44.3%（95%CI 38.8-49.7%）。在多变量模型中，残留/复发性/第二原发性肿瘤的临床肿瘤分期增加、颈清扫术时检出的转移性颈部淋巴结数量增加、下咽和喉上部肿瘤位置、阳性切缘状态和神经周围侵犯是 OS、DSS、DFS 和 LRFS 的独立负性预后因素。第二肿瘤类型被确定为 DSS 的另一个独立预后因素，局部复发和第二原发性肿瘤的预后优于残留肿瘤。