Noy Roee, Shkedy Yotam, Habashi Nadeem, Billan Salem, Cohen Jacob
Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Am J Otolaryngol. 2024 Jan-Feb;45(1):104109. doi: 10.1016/j.amjoto.2023.104109. Epub 2023 Nov 3.
Laser cordectomy is a widely accepted treatment modality for selected cases of early glottic cancers, but its role as a salvage treatment remains unclear. We aimed to investigate the oncological outcomes and failure patterns of salvage cordectomy.
This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival.
A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9).
Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.
激光声带切除术是早期声门癌特定病例广泛接受的治疗方式，但其作为挽救性治疗的作用仍不明确。我们旨在研究挽救性声带切除术的肿瘤学结局和失败模式。
这是一项对2013年至2022年在一家三级转诊中心因早期声门癌接受声带切除术患者的回顾性队列研究。主要结局指标为总生存期、喉保留率、气管造口依赖率和无病生存期。
共分析了142例患者（平均年龄：63岁，四分位间距[IQR]：45 - 72岁，123例[86.9%]为男性）。平均22个月（IQR：17 - 26个月）后有38例（26.8%）复发。其中，25例（17.6%）接受了挽救性声带切除术，而13例（9.1%）接受了其他挽救性治疗（11例[7.7%]为（化疗）放疗，2例[1.4%]为全喉切除术）。与其他挽救性治疗相比，挽救性声带切除术的气管造口率更低（0%对31%，p = 0.05），5年无病生存期相当（62%对54%，p = 0.4），5年喉保留率更高（92%对54%，p = 0.02），5年总生存率更高（84%对62%，p = 0.01）。与挽救性声带切除术失败相关的因素为年龄>60岁（比值比[OR]：1.3，95%置信区间[CI]：1.15 - 1.53）、持续吸烟（OR：3.73，95% CI：3.5 - 4.4）、重度吸烟（OR：1.24，95% CI：1.07 - 2.15）和pT1b +（OR：2.26，95% CI：2.1 - 2.9）。
对于适合保守手术的复发性疾病，挽救性声带切除术可提供良好的喉保留率和肿瘤学结局。吸烟、高龄和肿瘤晚期与挽救性声带切除术失败相关。
