Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy.
Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy.
Laryngoscope. 2021 Oct;131(10):2262-2268. doi: 10.1002/lary.29528. Epub 2021 Mar 23.
OBJECTIVES/HYPOTHESIS: To assess the disease control, survival rates, and prognostic factors of exclusive surgical treatment for patients with pT3 N0 laryngeal squamous cell carcinoma (LSCC).
Multicentric retrospective cohort study.
Multicentric retrospective case series of previously untreated patients with pT3 R0N0 LSCC, who received exclusive surgery between 2011 and 2019. Tumor location; subsite involvement; grading; and lymphatic, vascular, and perineural invasion were reported. Overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) were measured.
Fifty-four patients (mean age 67.1; male sex 83.3%; mean follow-up period 37 months) underwent total laryngectomy (48.1%) or partial laryngectomy (51.9%). Ipsilateral or bilateral neck dissection was performed in 46 (85.2%) cases. Perineural invasion was more frequent in case of supraglottic involvement than glottic involvement (85.7% vs. 14.3%, P = .03). Five (9.3%) patients experienced recurrence (3 local recurrences, 1 nodal recurrence, 1 distant recurrence). Rate of recurrence differed between glottic (0%), supraglottic (80%), and transglottic (20%) tumors (P = .01), with a lower risk yielded by glottic involvement (odds ratio [OR], 0.05, 95% confidence interval [95% CI], 0.01-0.56, P = .01). A higher risk was recorded in case of perineural invasion (OR, 66.0, 95% CI, 1.41-3085.3, P = .03). The OS, DSS, and DFS were 79.6%, 96.3%, and 90.7%, without differences regarding the type of surgery. The DFS was lower in case of supraglottic involvement when compared to purely glottic LSCC (83.9% vs. 100%, P = 0.02).
Exclusive surgery is a safe option for patients with pT3 R0N0 LSCC. Adjuvant treatments or closer follow-up monitoring might be considered in case of supraglottic involvement or perineural invasion.
4 Laryngoscope, 131:2262-2268, 2021.
目的/假设：评估单纯手术治疗 pT3N0 喉鳞状细胞癌（LSCC）患者的疾病控制、生存率和预后因素。
多中心回顾性队列研究。
多中心回顾性研究了 2011 年至 2019 年间接受单纯手术治疗的 pT3R0N0 LSCC 初治患者的病例系列。报告了肿瘤位置、亚部位受累、分级以及淋巴血管和神经周围侵犯情况。测量了总生存率（OS）、疾病特异性生存率（DSS）和无病生存率（DFS）。
54 例患者（平均年龄 67.1 岁；男性占 83.3%；平均随访时间 37 个月）行全喉切除术（48.1%）或部分喉切除术（51.9%）。46 例（85.2%）患者行同侧或双侧颈清扫术。与声门型受累相比，声门上型受累更常发生神经周围侵犯（85.7%比 14.3%，P=.03）。5 例（9.3%）患者出现复发（3 例局部复发，1 例淋巴结复发，1 例远处复发）。声门型（0%）、声门上型（80%）和跨声门型（20%）肿瘤的复发率不同（P=.01），声门型受累的复发风险较低（比值比[OR]，0.05，95%置信区间[95%CI]，0.01-0.56，P=.01）。神经周围侵犯的风险更高（OR，66.0，95%CI，1.41-3085.3，P=.03）。OS、DSS 和 DFS 分别为 79.6%、96.3%和 90.7%，手术类型之间无差异。与单纯声门型 LSCC 相比，声门上型受累的 DFS 较低（83.9%比 100%，P=.02）。
单纯手术是治疗 pT3R0N0 LSCC 患者的安全选择。如果存在声门上型受累或神经周围侵犯，可能需要辅助治疗或更密切的随访监测。
4 Laryngoscope，131：2262-2268，2021。
