Ketterer Manuel Christoph, Hoffmann Thomas K, Laban Simon, Berghaus Alexander, Canis Martin, Jacobi Christian, Klussmann Jens Peter, Foeringer Wendelin, Laszig Roland, Pfeiffer Jens, Bier Henning, Knopf Andreas
Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Centre Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5, 79106, Freiburg, Germany.
Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
Eur Arch Otorhinolaryngol. 2025 Jun 14. doi: 10.1007/s00405-025-09460-3.
This retrospective study examined overall survival (OS), recurrence free survival (RFS), and laryngeal preservation time in a large cohort of 663 patients with T1/2 N0 M0 glottic cancer after transoral laser or open surgery vs radiotherapy.
A total of 595 surgically treated patients and 68 individuals after definitive radio(chemo)therapy (R (C)-T) were studied. Patient characteristics including sociological, surgical, and pathological data, OS and RFS as well as laryngeal preservation time were recorded and compared between various groups/cohorts.
There were no significant differences in OS and RFS between surgically treated and conservatively treated patients. However, laryngeal preservation time was significantly higher in surgically treated patients (p < 0.001) (mean: 138.3 ± 2.2 months, versus 102.8 ± 7.6 months) than those under conservative treatment. The surgical treatment method (transoral vs. open partial resection) did not influence OS or RFS. Additionally, the rate of transoral vs. open surgery did not change over a decade. T2-stage patients showed significantly lower RFS than T1-stage patients. Initial R status significantly influenced OS and tumor recurrence.
The findings of this study exhibited a significantly longer laryngeal preservation time in patients with T1/2 N0 M0 glottic cancer treated surgically than in those treated with radiotherapy. No significant differences in OS or RFS were observed between open partial laryngectomy and transoral laser surgery. The R status had a significant impact on OS and RFS, with OS being significantly associated with an R0 status, regardless of T status or the surgical approach (open versus transoral). Laryngeal preservation surgery is recommended as a central therapeutic strategy for T1/2 N0 M0 glottic cancer because it has a higher laryngeal preservation rate than the conservative treatment. Given the high recurrence rate (18.5%) and the necessity of laryngo- (pharyng) ectomy in a substantial proportion of recurrent patients (7.7%), the choice of initial therapeutic approach is critical.
本回顾性研究调查了663例T1/2 N0 M0声门癌患者在接受经口激光手术或开放手术与放射治疗后的总生存期（OS）、无复发生存期（RFS）和喉保留时间。
共研究了595例接受手术治疗的患者和68例接受根治性放（化）疗（R（C）-T）的患者。记录患者的社会学、手术和病理数据等特征、OS和RFS以及喉保留时间，并在不同组/队列之间进行比较。
手术治疗患者和保守治疗患者的OS和RFS无显著差异。然而，手术治疗患者的喉保留时间显著高于保守治疗患者（p＜0.001）（平均：138.3±2.2个月，对比102.8±7.6个月）。手术治疗方法（经口与开放部分切除术）不影响OS或RFS。此外，经口手术与开放手术的比例在十年间没有变化。T2期患者的RFS显著低于T1期患者。初始R状态显著影响OS和肿瘤复发。
本研究结果显示，T1/2 N0 M0声门癌手术治疗患者的喉保留时间显著长于放射治疗患者。开放部分喉切除术和经口激光手术在OS或RFS方面无显著差异。R状态对OS和RFS有显著影响，无论T状态或手术方式（开放与经口）如何，OS与R0状态显著相关。建议将喉保留手术作为T1/2 N0 M0声门癌的核心治疗策略，因为其喉保留率高于保守治疗。鉴于高复发率（18.5%）以及相当比例的复发患者（7.7%）需要行喉（咽）切除术，初始治疗方法的选择至关重要。
