IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy.
Eur Arch Otorhinolaryngol. 2022 Jan;279(1):299-310. doi: 10.1007/s00405-021-07076-x. Epub 2021 Sep 24.
Non-squamous cell carcinoma (non-SCC) accounts for about 5% of laryngeal malignancies. Survival data are limited, and consensus on management principles is lacking. The present study reviews our experience in the surgical treatment of non-metastatic non-SCC of the larynx and compares oncological and functional outcomes in a cohort of patients affected by traditional SCC.
We collected data on 592 patients affected by laryngeal neoplasms. Univariate and multivariable survival analyses were performed using Cox proportional-hazards models; survival estimates were reported by hazard ratios (HR) with 95% confidence intervals (CI), and survival curves were established with the Kaplan-Meier method.
We identified 326 patients affected by untreated SCC, while 21 had non-SCC histotypes. The non-SCC cohort was composed of 5 soft tissue sarcomas, 8 chondrosarcomas, 2 adenoid cystic carcinomas, 2 neuroendocrine carcinomas, 2 solitary fibrous tumors, 1 Kaposi's sarcoma, and 1 malignant peripheral nerve sheath tumor. Overall survival and disease-specific survival were not significantly different according to histology (p = 0.6 and p = 0.349, respectively). The non-SCC group showed an increased risk of recurrence (HR 5.87; CI 2.15-16.06; p < 0.001). Nonetheless, no significant difference (p = 0.31) was found at multivariable analysis between the two groups in total laryngectomy-free survival with an organ preservation rate over 5 years of 81% for the non-SCC histologies.
Non-SCC is a broad spectrum pathology, but generalized laryngeal surgical management principles are still feasible and it is possible to identify patients amenable to conservative surgical treatment without affecting survival.
非鳞状细胞癌（非 SCC）约占喉恶性肿瘤的 5%。目前生存数据有限，且缺乏管理原则的共识。本研究回顾了我们在非转移性喉非 SCC 手术治疗方面的经验，并将一组受传统 SCC 影响的患者的肿瘤学和功能结果进行了比较。
我们收集了 592 例喉肿瘤患者的数据。使用 Cox 比例风险模型进行单变量和多变量生存分析；生存估计值通过风险比（HR）及其 95%置信区间（CI）报告，并通过 Kaplan-Meier 方法建立生存曲线。
我们发现 326 例未经治疗的 SCC 患者，21 例为非 SCC 组织学类型。非 SCC 队列由 5 例软组织肉瘤、8 例软骨肉瘤、2 例腺样囊性癌、2 例神经内分泌癌、2 例孤立性纤维瘤、1 例卡波西肉瘤和 1 例恶性外周神经鞘瘤组成。根据组织学，总生存率和疾病特异性生存率无显著差异（p=0.6 和 p=0.349）。非 SCC 组复发风险增加（HR 5.87；CI 2.15-16.06；p<0.001）。然而，多变量分析显示，两组在全喉切除术无复发生存方面无显著差异（p=0.31），5 年以上器官保留率为 81%。
非 SCC 是一种广泛的病理类型，但仍可采用一般性的喉部外科处理原则，并且可以识别出适合保守手术治疗而不影响生存率的患者。
