Meulemans Jeroen, Narimani Sara, Hauben Esther, Nuyts Sandra, Laenen Annouschka, Delaere Pierre, Vander Poorten Vincent
Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.
Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium.
Front Oncol. 2021 May 4;11:685255. doi: 10.3389/fonc.2021.685255. eCollection 2021.
BACKGROUND/PURPOSE: The value of margin status after TLM for glottic cancer is debatable, due to difficulties in specimen orientation and margin analysis. To reduce these difficulties, we recently introduced a standardized protocol of oriented fixation of TLM specimens. This proved feasible and resulted in high margin evaluability rates and a decreased rate of false positive deep margins, when compared to a historical TLM cohort. For the patients whose specimens were processed according to this protocol, we prospectively analyzed oncological outcomes, identified prognostic factors and assessed the influence of the protocol introduction on outcomes compared with a historical TLM cohort.
Ninety-six patients with glottic malignancies treated with TLM were included. Resection specimens were processed according to the new protocol. Descriptive statistics and survival analyses were used to determine oncological outcomes. To assess the effect of the protocol introduction on outcomes, a matched-case-control analysis was performed, using a historical TLM-cohort as controls. The Cox proportional hazards model was used to analyze prognostic effects of patient and treatment characteristics, including the pathology protocol introduction, on overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and local recurrence-free survival (LRFS).
Two-year outcomes were favorable: 88.5% OS, 97.0% DSS, and 87.6% LRFS. At multivariable analysis, the presence of multiple positive superficial margins was a negative prognosticator for OS (HR 4.102) and increasing cT classification proved a negative prognosticator for DFS (HR 2.828) and LRFS (HR 2.676). Matched case-control analysis did not reveal a significant difference in oncological outcomes between cohorts. Deep margin status had a strong differential effect for DFS (p-value for interaction = 0.0205) and for LRFS (p-value for interaction = 0.0176) between cohorts, indicating a prognostic effect of deep margin status on both outcomes in the current cohort, but not in the historical cohort.
DISCUSSION/CONCLUSION: The introduction of a new standardized technique of oriented fixation of TLM specimens did not affect oncological outcomes when compared to a historical TLM cohort, but assigned a significant prognostic effect to deep margin status for DFS and LRFS, facilitating the decision making process with regards to planning of second-look procedures, administration of adjuvant radiotherapy or determination of follow-up intensity.
背景/目的：由于标本定位和切缘分析存在困难，声门癌经支撑喉镜下切除术（TLM）后切缘状态的价值存在争议。为减少这些困难，我们最近引入了一种标准化的TLM标本定向固定方案。与历史TLM队列相比，这一方案被证明是可行的，且切缘评估率高，假阳性深部切缘率降低。对于按照该方案处理标本的患者，我们前瞻性地分析了肿瘤学结局，确定了预后因素，并评估了该方案的引入对结局的影响，并与历史TLM队列进行了比较。
纳入96例行TLM治疗的声门恶性肿瘤患者。切除标本按照新方案进行处理。采用描述性统计和生存分析来确定肿瘤学结局。为评估方案引入对结局的影响，以历史TLM队列作为对照进行配对病例对照分析。采用Cox比例风险模型分析患者和治疗特征（包括病理方案的引入）对总生存（OS）、疾病特异性生存（DSS）、无病生存（DFS）和无局部复发生存（LRFS）的预后影响。
两年的结局良好：OS为88.5%，DSS为97.0%，LRFS为87.6%。多变量分析时，多个阳性浅表切缘的存在是OS的不良预后因素（HR 4.102），cT分级增加被证明是DFS（HR 2.828）和LRFS（HR 2.676）的不良预后因素。配对病例对照分析未显示队列之间肿瘤学结局存在显著差异。深部切缘状态在队列之间对DFS（交互作用p值 = 0.0205）和LRFS（交互作用p值 = 0.0176）有强烈的差异效应，表明深部切缘状态对当前队列的这两种结局均有预后影响，但对历史队列没有影响。
讨论/结论：与历史TLM队列相比，新的标准化TLM标本定向固定技术的引入并未影响肿瘤学结局，但深部切缘状态对DFS和LRFS具有显著的预后影响，有助于在决定二次手术计划、辅助放疗管理或确定随访强度方面的决策过程。
