在国家退伍军人数据库中，经口激光微创手术治疗早期声门型喉癌的挽救治疗。

Salvage Following Transoral Laser Microsurgery for Early Glottic Cancer in National Veteran Database.

机构信息

University of California, San Diego School of Medicine, La Jolla, California, U.S.A.

Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California-San Diego, San Diego, California, U.S.A.

出版信息

Laryngoscope. 2021 Dec;131(12):2766-2772. doi: 10.1002/lary.29740. Epub 2021 Jul 23.

DOI:10.1002/lary.29740

PMID:34296772

Abstract

OBJECTIVES

Transoral laser microsurgery (TLM) is commonly utilized for early glottic cancer and offers favorable oncologic and functional outcomes. However, the survival implications of salvage therapy for recurrent or persistent disease have not been definitively characterized.

STUDY DESIGN

Retrospective, national database cohort study.

METHODS

Data were extracted from Veterans Health Affairs (VHA) Informatics and Computing Infrastructure (VINCI) concerning the TLM-based management of T1-T2 glottic squamous cell carcinoma patients between 2000 and 2017. Patients were characterized as either requiring TLM-only, or in cases of persistent or recurrent local disease, TLM plus change in treatment modality (radiotherapy, chemoradiotherapy, or open surgery). Predictors of overall survival (OS), cancer-specific survival (CSS), and salvage-free survival were evaluated via Cox and Fine-Gray models.

RESULTS

About 553 patients (70.9% T1a, 13.4% T1b, 15.7% T2) were included, with a median follow-up time of 74.5 months. The need for non-TLM salvage increased along with more advanced disease (11.7% T1a, 29.7% T1b, 32.2% T2). Compared to patients with T1a disease, those with T1b and T2 tumors initially treated with TLM had a significantly higher probability of receiving non-TLM salvage (T1b: HR 2.70, 95% CI: 1.61-4.54; T2: HR 3.02, 95% CI: 1.88-4.84). In a multivariable model, receipt of non-TLM salvage was not a significant predictor of either OS (HR = 0.91, 95% CI: 0.62-1.33, P = .624) or CSS (HR 1.21 95% CI 0.51-2.86, P = .667).

CONCLUSION

The majority of patients with early glottic cancer that are managed with TLM do not require additional salvage therapy. When non-TLM salvage was required, there was no decrement in OS or CSS.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:2766-2772, 2021.

摘要

目的

经口激光显微手术（TLM）常用于治疗早期声门型癌症，能提供良好的肿瘤学和功能预后。然而，对于复发性或持续性疾病的挽救性治疗的生存意义尚未明确。

研究设计

回顾性、全国性数据库队列研究。

方法

从退伍军人事务部（VA）信息学和计算基础设施（VINCI）中提取了 2000 年至 2017 年间 TLM 治疗 T1-T2 声门型鳞状细胞癌患者的数据。患者分为仅接受 TLM 治疗或在局部疾病持续或复发的情况下接受 TLM 加治疗方式改变（放疗、放化疗或开放性手术）。通过 Cox 和 Fine-Gray 模型评估总生存（OS）、癌症特异性生存（CSS）和挽救性无失败生存的预测因素。

结果

共纳入 553 例患者（70.9% T1a，13.4% T1b，15.7% T2），中位随访时间为 74.5 个月。随着疾病的进展，需要非 TLM 挽救治疗的患者比例增加（11.7% T1a，29.7% T1b，32.2% T2）。与 T1a 疾病患者相比，最初接受 TLM 治疗的 T1b 和 T2 肿瘤患者更有可能接受非 TLM 挽救治疗（T1b：HR 2.70，95%CI：1.61-4.54；T2：HR 3.02，95%CI：1.88-4.84）。在多变量模型中，接受非 TLM 挽救治疗并不是 OS（HR=0.91，95%CI：0.62-1.33，P=0.624）或 CSS（HR 1.21，95%CI 0.51-2.86，P=0.667）的显著预测因素。