Mo Hailan, Fang Hongyan, Luo Rui, Liao Xiufu, Gao Leilei, Song Mei, Zhou Xia, Yuan Wei
Department of Otolaryngology,Chongqing General Hospital,Chongqing,400014,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 May;37(5):354-359. doi: 10.13201/j.issn.2096-7993.2023.05.007.
To analyze the risk factors of recurrence and canceration for premalignant vocal fold lesions after surgery, and to provide a reasonable basis for preoperative evaluation and postoperative follow-up. This study retrospective analyzed the relationship between clinicopathological factors and clinical outcome(recurrence, canceration, recurrence-free survival, and canceration-free survival) in 148 patients undergoing surgical treatment in Chongqing General Hospital from 2014 to 2017. The five-year overall recurrence rate was 14.86% and the overall recurrence rate was 8.78%. Univariate analysis showed that smoking index, laryngopharyngeal reflux and lesion range were significantly associated with recurrence(<0.05), and smoking index and lesion range were significantly associated with canceration<0.05). Multivariate logistic regression analysis showed that smoking index ≥600 and laryngopharyngeal reflux were independent risk factors for recurrence(<0.05), and smoking index ≥600 and lesion range ≥1/2 vocal cord were independent risk factors for canceration(<0.05). The mean carcinogenesis interval for the postoperative smoking cessation group was significantly longer(<0.05). Excessive smoking, laryngopharyngeal reflux and a wide range of lesions may be related to postoperative recurrence or malignant progression of precancerous lesions in the vocal cord, and further large-scale multi-center prospective randomized controlled studies are needed to clarify the effects of the above factors on recurrence and malignant changes in the future.
分析声带癌前病变手术后复发和癌变的危险因素,为术前评估和术后随访提供合理依据。本研究回顾性分析了2014年至2017年在重庆总医院接受手术治疗的148例患者的临床病理因素与临床结局(复发、癌变、无复发生存率和无癌生存率)之间的关系。五年总复发率为14.86%,总癌变率为8.78%。单因素分析显示,吸烟指数、咽喉反流和病变范围与复发显著相关(P<0.05),吸烟指数和病变范围与癌变显著相关(P<0.05)。多因素logistic回归分析显示,吸烟指数≥600和咽喉反流是复发的独立危险因素(P<0.05),吸烟指数≥600和病变范围≥1/2声带是癌变的独立危险因素(P<0.05)。术后戒烟组的平均癌变间隔时间明显更长(P<0.05)。吸烟过量、咽喉反流和病变范围广可能与声带癌前病变术后复发或恶性进展有关,未来需要进一步开展大规模多中心前瞻性随机对照研究,以明确上述因素对复发和恶变的影响。