Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada.
JAMA Otolaryngol Head Neck Surg. 2021 Dec 1;147(12):1027-1034. doi: 10.1001/jamaoto.2021.1545.
Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and overall survival in laryngeal cancer remains uncertain.
To determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival.
DESIGN, SETTING, AND PARTICIPANTS: A multicenter collaborative retrospective cohort study conducted at 5 centers in Canada and the US of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer from January 1, 2000, to December 31, 2014. The median follow-up time was 5.7 years (range, 0-18 years).
Outcomes examined included locoregional and distant control, disease-free survival, and overall survival. Fine and Gray competing risk regression and Cox-proportional hazard regression models were used for outcomes. Competing risks and the Kaplan-Meier methods were used to estimate outcomes at 3 years and 5 years.
In all, 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Pharyngocutaneous fistula occurred in 127 patients (23%). The difference in locoregional control between the group of patients with PCF (75%) and the non-PCF (72%) group was 3% (95% CI, -6% to 12%). The difference in overall survival between the group with PCF (44%) and the non-PCF group (52%) was 8% (95% CI, -2% to 20%). The difference in disease-free survival between PCF and non-PCF groups was 6% (95% CI, -4% to 16%). In the multivariable model, patients with PCF were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with PCF, a 13% (95% CI, 3% to 21%) difference in 5-year distant control.
This multicenter retrospective cohort study found that development of PCF after salvage laryngectomy is associated with an increased risk for the development of distant metastases.
咽皮瘘（PCF）会引起炎症反应，但它与喉癌患者的局部区域和远处控制、无病生存率以及总生存率的关系尚不确定。
确定挽救性喉切除术（salvage laryngectomy）后发生咽皮瘘是否与局部区域和远处控制、无病生存率和/或总生存率相关。
设计、地点和参与者：这是一项多中心协作回顾性队列研究，在加拿大和美国的 5 个中心开展，纳入了 550 例 2000 年 1 月 1 日至 2014 年 12 月 31 日因复发性喉癌接受挽救性喉切除术的患者。中位随访时间为 5.7 年（范围 0-18 年）。
分析的结局包括局部区域和远处控制、无病生存率以及总生存率。使用 Fine 和 Gray 竞争风险回归和 Cox 比例风险回归模型评估结局。使用竞争风险和 Kaplan-Meier 方法估计 3 年和 5 年的结局。
共有 550 例患者（平均[标准差]年龄 64[10.4]岁；男性 465[85%]）符合纳入标准。127 例患者（23%）发生咽皮瘘。咽皮瘘组（75%）与非咽皮瘘组（72%）患者的局部区域控制率差异为 3%（95%CI，-6%至 12%）。咽皮瘘组（44%）与非咽皮瘘组（52%）患者的总生存率差异为 8%（95%CI，-2%至 20%）。无病生存率的差异为 6%（95%CI，-4%至 16%）。在多变量模型中，咽皮瘘患者远处转移的风险增加了 2 倍（风险比，2.00；95%CI，1.22 至 3.27）。咽皮瘘患者的远处控制降低，5 年远处控制的差异为 13%（95%CI，3%至 21%）。
这项多中心回顾性队列研究发现，挽救性喉切除术后发生咽皮瘘与远处转移的风险增加有关。
