Kitano Mutsukazu, Koike Satoru, Tamaki Hisatomo, Iwamoto Shusuke, Miyamoto Kazuhiro, Ohira Noriko, Kimura Takayuki, Sato Mitsuo, Yasumatsu Ryuji
Department of Otolaryngology-Head and neck surgery, Faculty of Medicine, Kindai University, Osaka, Japan.
Cancer Diagn Progn. 2023 May 3;3(3):347-353. doi: 10.21873/cdp.10222. eCollection 2023 May-Jun.
BACKGROUND/AIM: Sarcopenia has an adverse effect on postoperative complications and prognoses in head and neck cancer. This study focused on hypopharyngeal and laryngeal cancer patients with sarcopenia and analyzed the body composition following treatment when the larynx was preserved and when total laryngectomy was performed to examine the usefulness of laryngectomy.
We retrospectively reviewed 88 primary hypopharyngeal and laryngeal cancer patients aged 65 years or older with cT2N0M0 or higher who visited our department.
There were no significant differences in the 3-year overall survival rate and the 1-year local control rate between the laryngeal preservation group and laryngectomy group. The average change one year following treatment in the laryngeal preservation group, when compared to prior to treatment, was a significant decrease in the body weight (BW) of -0.035, skeletal muscle mass (SMM) of -0.030, skeletal muscle mass index (SMI) of -0.026, body mass index (BMI) of -0.034, and grip strength (GS) of -0.066. The average change one year following treatment in the laryngectomy group, compared with prior to treatment, was an increase in BW of +0.028, SMM of +0.026, SMI of +0.008, BMI of +0.032, and GS of +0.026. Although no changes in serum biochemical testing after treatment were observed in the laryngeal preservation group, albumin, transferrin, and transthyretin all exhibited significant improvement or a tendency toward improvement in the laryngectomy group. The patients with sarcopenia before treatment in the laryngeal preservation group had a significantly higher incidence of aspiration pneumonia.
The presence or absence of sarcopenia before starting treatment is considered to be an index for selecting total laryngectomy.
背景/目的：肌肉减少症对头颈部癌术后并发症及预后有不良影响。本研究聚焦于患有肌肉减少症的下咽癌和喉癌患者，分析了在保留喉和进行全喉切除术后的身体成分，以探讨喉切除术的效用。
我们回顾性分析了88例年龄在65岁及以上、cT2N0M0或更高分期的原发性下咽癌和喉癌患者，这些患者均就诊于我科。
喉保留组和喉切除组的3年总生存率及1年局部控制率无显著差异。与治疗前相比，喉保留组治疗后1年的平均变化为体重（BW）显著下降-0.035、骨骼肌质量（SMM）下降-0.030、骨骼肌质量指数（SMI）下降-0.026、体重指数（BMI）下降-0.034、握力（GS）下降-0.066。与治疗前相比，喉切除组治疗后1年的平均变化为BW增加+0.028、SMM增加+0.026、SMI增加+0.008、BMI增加+0.032、GS增加+0.026。喉保留组治疗后血清生化检测无变化，而喉切除组白蛋白、转铁蛋白和甲状腺素转运蛋白均显著改善或有改善趋势。喉保留组治疗前患有肌肉减少症的患者发生吸入性肺炎的发生率显著更高。
开始治疗前是否存在肌肉减少症被认为是选择全喉切除术的一个指标。
