Ying Shengjie, Zeng Peter Y F, Fung Kevin, Khan Halema, Cecchini Matthew J, MacInnis Patrick, Anderson Jennifer, Karimi Amir H, Al Jawhri MohdWessam, Pan Harrison, Le Nhi, Joris Krista, Mymryk Joe S, Dumeaux Vanessa, Barrett John W, Nichols Anthony C, Lin R Jun
Department of Otolaryngology-Head & Neck Surgery, Western University, London, Ontario, Canada.
Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada.
Laryngoscope. 2025 Sep;135(9):3265-3272. doi: 10.1002/lary.32179. Epub 2025 Apr 16.
Serial intralesional steroid injections (ILSIs) have been suggested to be an effective adjunct treatment for idiopathic subglottic stenosis (iSGS) by maintaining airway patency and extending inter-surgical intervals. However, evidence for the effectiveness of serial ILSIs remains inconclusive. The current study aimed to assess whether ILSIs reduce the risk of subsequent surgical dilation (i.e., recurrence) in a cohort of patients with iSGS.
Prospectively collected clinical data for 75 female iSGS patients with 1-4 years of follow-up were analyzed. To assess the effect of ILSI use on the risk of recurrence, we assessed both the time-to-first recurrence using a standard Cox proportional hazards model and all recurrences per patient using a recurrent-events model. Overall, there were 36 patients who had received ILSIs at any point in the follow-up period and 39 patients who had not.
ILSI use was associated with a significantly reduced risk of recurrence in both time-to-first event (hazard ratio (HR) = 0.20, 95% confidence interval (CI) 0.08-0.49) and recurrent events (HR = 0.44, 95% CI 0.26-0.75) multivariate Cox proportional hazard models, along with older age at diagnosis and longer time since diagnosis (all p < 0.05). In the time-to-first event analysis, the median time to recurrence among those who had received ILSIs was 2.5 years compared to 1.4 years among those who had not. The number needed to treat with ILSIs to avoid one recurrence by 2 years follow-up was two.
Serial ILSIs were associated with reduced risk of recurrence, along with older age at diagnosis and longer time since diagnosis.
3 (non-randomized controlled cohort/follow-up study).
连续病灶内注射类固醇（ILSIs）被认为是治疗特发性声门下狭窄（iSGS）的一种有效辅助治疗方法，可维持气道通畅并延长手术间隔时间。然而，连续ILSIs有效性的证据仍不确凿。本研究旨在评估ILSIs是否能降低iSGS患者队列中后续手术扩张（即复发）的风险。
对前瞻性收集的75例女性iSGS患者的临床数据进行分析，随访时间为1至4年。为评估使用ILSIs对复发风险的影响，我们使用标准Cox比例风险模型评估首次复发时间，并使用复发事件模型评估每位患者的所有复发情况。总体而言，在随访期间有36例患者在任何时间接受了ILSIs，39例患者未接受。
在首次事件时间（风险比（HR）=0.20，95%置信区间（CI）0.08 - 0.49）和复发事件（HR = 0.44，95%CI 0.26 - 0.75）的多变量Cox比例风险模型中，使用ILSIs与复发风险显著降低相关，同时与诊断时年龄较大和诊断后时间较长有关（所有p < 0.05）。在首次事件时间分析中，接受ILSIs的患者复发的中位时间为2.5年，而未接受的患者为1.4年。通过2年随访避免一次复发所需的ILSIs治疗人数为2人。
连续ILSIs与复发风险降低相关，同时与诊断时年龄较大和诊断后时间较长有关。
3（非随机对照队列/随访研究）
