Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel.
The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
Eur Arch Otorhinolaryngol. 2024 Feb;281(2):935-943. doi: 10.1007/s00405-023-08302-4. Epub 2023 Oct 25.
Patients with laryngeal cancer may necessitate tracheostomy placement to alleviate compromised airways. However, the impact of tracheostomy on thyroid gland invasion and its implications for prognosis in individuals who further undergo total laryngectomy remains unclear. This study aimed to assess thyroid gland invasion rates and explore the 5-years disease-free and overall survival in laryngectomized patients stratified by preoperative tracheostomy.
All patients who underwent total laryngectomy for laryngeal cancer between 2003 and 2023 at a tertiary referral center were retrospectively reviewed. Logistic univariable and multivariable regressions were performed to identify factors associated with thyroid gland invasion. Survival analyses were performed using the Kaplan-Meier estimator.
A total of 119 laryngectomized patients were included (mean age: 63 ± 10 years, range 35-89, 110 [92.4%] males); 27 (22.7%) underwent preoperative tracheostomy. In 16 (13.4%) patients, tumor cells were found within the thyroid gland. In a multivariable analysis, thyroid gland invasion was independently associated with preoperative tracheostomy (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.45-6.19), pN2 + (OR 2.13, 95% CI 1.8-5.14), positive margins (OR 1.36, 95% CI 1.01-1.77), lower 5-year disease-free survival (38% vs. 57%, p = 0.01), and lower 5-year overall survival (40% vs. 56%, p = 0.03).
Preoperative tracheostomy is an independent predictive factor for thyroid gland invasion and has adverse oncological outcomes in laryngectomized patients. Conversely, the rates of thyroid gland invasion are low when tracheostomy was not performed beforehand.
喉癌患者可能需要进行气管切开术以缓解气道阻塞。然而，气管切开术对甲状腺侵犯的影响及其对进一步接受全喉切除术的患者预后的影响尚不清楚。本研究旨在评估甲状腺侵犯率，并探讨术前气管切开术分层的喉切除患者的 5 年无病生存率和总生存率。
回顾性分析 2003 年至 2023 年间在一家三级转诊中心接受全喉切除术治疗喉癌的所有患者。采用逻辑单变量和多变量回归分析确定与甲状腺侵犯相关的因素。采用 Kaplan-Meier 估计器进行生存分析。
共纳入 119 例接受全喉切除术的患者（平均年龄：63±10 岁，范围 35-89 岁，110[92.4%]例男性；27[22.7%]例术前行气管切开术。16[13.4%]例患者的甲状腺内发现肿瘤细胞。多变量分析显示，术前气管切开术与甲状腺侵犯独立相关（优势比[OR]3.13，95%置信区间[CI]2.45-6.19），pN2+（OR 2.13，95%CI 1.8-5.14），阳性切缘（OR 1.36，95%CI 1.01-1.77），5 年无病生存率较低（38%vs.57%，p=0.01），5 年总生存率较低（40%vs.56%，p=0.03）。
术前气管切开术是甲状腺侵犯的独立预测因素，对接受全喉切除术的患者有不良的肿瘤学预后。相反，未行气管切开术时甲状腺侵犯率较低。
