Chen Xuejun, Huang Junwei, Ding Shuo, Yin Gaofei, Gao Wen, Zhang Yang, Huang Zhigang
Department of Otorhinolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Ann Transl Med. 2022 Jul;10(14):799. doi: 10.21037/atm-22-3385.
Although lymph node metastasis is a critical prognostic factor, the indications for neck dissection in recurrent glottic cancer after transoral laser microsurgery (TLM) are unclear. At present, there is no clear standard for simultaneous cervical lymph node dissection at home and abroad.
We summarize the pattern of regional recurrence in glottic cancer after initial TLM and to evaluate the risk factors for neck metastasis. Seventy-five cases with recurrent glottic cancer after TLM between December 2004 and June 2014 were retrospectively analyzed. Survival, regional control rate, and neck metastasis were analyzed. The Kaplan-Meier method was used for survival analysis. Univariate analysis was performed with the log-rank test and multivariate analysis was completed using Cox regression.
The 5-year overall survival (OS), disease-specific survival (DSS), and regional control rate after the first TLM were 73.6%, 89.1%, and 69.7%, respectively. A total of 22 (29.3%) patients developed cervical metastases during long-term follow-up and showed a significant decline in OS and DSS rates. Multivariate analysis indicated that histological grading and type of TLM were both risk factors for neck metastasis. Patients treated with type Vc cordectomy were more likely to develop regional recurrence than patients treated with type III cordectomy [hazard ratio (HR) =14.737, 95% confidence interval (CI): 2.117-102.610, P=0.007]. No significant correlation was present between rT stage and neck metastasis.
Multivariate analysis indicated that histological grading and type of TLM were both risk factors for neck metastasis. Patients with recurrence after type V cordectomy may have an increased risk of developing cervical lymph node metastasis, especially those with supraglottic spread or high-grade tumors.
尽管淋巴结转移是一个关键的预后因素，但经口激光显微手术（TLM）后复发性声门癌颈部清扫术的指征尚不清楚。目前，国内外对于同期颈部淋巴结清扫术尚无明确标准。
我们总结了初次TLM后声门癌区域复发的模式，并评估颈部转移的危险因素。回顾性分析了2004年12月至2014年6月期间75例TLM后复发性声门癌患者。分析了生存率、区域控制率和颈部转移情况。采用Kaplan-Meier法进行生存分析。单因素分析采用对数秩检验，多因素分析采用Cox回归。
首次TLM后的5年总生存率（OS）、疾病特异性生存率（DSS）和区域控制率分别为73.6%、89.1%和69.7%。共有22例（29.3%）患者在长期随访中发生颈部转移，且OS和DSS率显著下降。多因素分析表明，组织学分级和TLM类型均为颈部转移的危险因素。与接受III型声带切除术的患者相比，接受Vc型声带切除术的患者更易发生区域复发[风险比（HR）=14.737，95%置信区间（CI）：2.117 - 102.610，P = 0.007]。rT分期与颈部转移之间无显著相关性。
多因素分析表明，组织学分级和TLM类型均为颈部转移的危险因素。V型声带切除术后复发的患者发生颈部淋巴结转移的风险可能增加，尤其是那些声门上扩散或高级别肿瘤的患者。
