Patel Depak, Taylor Victoria, MacKay Colin, den Besten Chrisje, Rigby Matthew H, Corsten Martin, Brown Timothy, Trites Jonathan, Taylor S Mark
Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada.
Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
J Otolaryngol Head Neck Surg. 2025 Jan-Dec;54:19160216251348424. doi: 10.1177/19160216251348424. Epub 2025 Jun 18.
ImportanceThere is a limited understanding of anterior commissure (AC) involvement in glottic squamous cell carcinoma (SCC), particularly when comparing T1b, T2a with AC involvement (T2AC), and T2a without AC involvement (T2noAC).ObjectiveThe aim of this study was to compare oncological and functional outcomes in T1b, T2AC, and T2noAC glottic SCC following transoral laser microsurgery (TLM).DesignRetrospective chart review.SettingThe Queen Elizabeth II Health Science Centre (Halifax, Nova Scotia) from January 1, 2002, to December 31, 2022.Intervention and ExposuresA retrospective chart review was completed using prospectively-collected data for patients treated with TLM for T1b and T2a glottic SCC. Exclusion criteria included previous treatment for a laryngeal cancer and T2b glottic SCC.Main Outcome MeasuresOncological outcomes were assessed using margin status, local control (LC), disease-specific survival (DSS), overall survival (OS), and laryngeal preservation (LP). Functional outcomes were measured using the abbreviated Voice Handicap Index-10 (VHI-10).ResultsIn total, 117 patients were included (T1b = 46, T2AC = 53, T2noAC = 18). Positive margins were higher in the T2AC group (15.1%) than in T1b (4.3%) and T2noAC (5.6%; = .208). At 5 years, there were no significant differences in LC (T1b = 80.8%, T2AC = 70.3%, T2noAC = 76.2%; = .26), DSS (T1b = 100%, T2AC = 90.2%, T2noAC = 93.8%; = .45), OS (T1b = 88.3%, T2AC = 76.1%, T2noAC = 93.8%; = .69), or LP (T1b = 94.3%, T2AC = 92.1%, T2noAC = 94.4%; = .74). Significant improvements in VHI-10 scores from the pre- to postoperative period were only noted in the T1b cohort, at the 6 months ( = .017) and the 12 months ( = .00143).ConclusionsNo significant differences in both oncological and functional outcomes were noted between T1b, T2AC, and T2noAC glottic SCCs. Further stratifying based on the degree and pattern of AC involvement with larger sample sizes may provide important prognostic factors.RelevanceThis study highlights that T2 glottic SCCs with normal vocal fold mobility are a heterogenous group, and it may be beneficial to further stratify these cancers according to AC involvement, particularly when considering TLM.
重要性
目前对于前联合（AC）受累在声门鳞状细胞癌（SCC）中的情况了解有限，尤其是在比较T1b、伴有AC受累的T2a（T2AC）和不伴有AC受累的T2a（T2noAC）时。
目的
本研究的目的是比较经口激光显微手术（TLM）治疗后T1b、T2AC和T2noAC声门SCC的肿瘤学和功能结局。
设计
回顾性病历审查。
背景
伊丽莎白二世健康科学中心（新斯科舍省哈利法克斯），时间跨度为2002年1月1日至2022年12月31日。
干预与暴露
使用前瞻性收集的接受TLM治疗的T1b和T2a声门SCC患者的数据完成回顾性病历审查。排除标准包括既往有喉癌治疗史和T2b声门SCC。
主要结局指标
使用切缘状态、局部控制（LC）、疾病特异性生存（DSS）、总生存（OS）和喉保留（LP）评估肿瘤学结局。使用简化嗓音障碍指数-10（VHI-10）测量功能结局。
结果
总共纳入117例患者（T1b = 46例，T2AC = 53例，T2noAC = 18例）T2AC组的阳性切缘（15.1%）高于T1b组（4.3%）和T2noAC组（5.6%；P = 0.208）。5年时，LC（T1b = 80.8%，T2AC = 70.3%，T2noAC = 76.2%；P = 0.26）、DSS（T1b = 100%，T2AC = 90.2%，T2noAC = 93.8%；P = 0.45）、OS（T1b = 88.3%，T2AC = 76.1%，T2noAC = 93.8%；P = 0.69）或LP（T1b = 94.3%，T2AC = 92.1%，T2noAC = 94.4%；P = 0.74）方面均无显著差异。仅在T1b队列中，术后6个月（P = 0.017）和12个月（P = 0.00143）时VHI-10评分从术前到术后有显著改善。
结论
T1b、T2AC和T2noAC声门SCC在肿瘤学和功能结局方面均无显著差异。基于更大样本量进一步根据AC受累程度和模式进行分层可能会提供重要的预后因素。
相关性
本研究强调声带活动正常的T2声门SCC是一个异质性群体，根据AC受累情况进一步对这些癌症进行分层可能是有益的，尤其是在考虑TLM时。
