经活检证实的喉原位鳞状细胞癌的治疗。

Treatment of Biopsy-Proven Laryngeal Squamous Cell Carcinoma In Situ.

作者信息

Kaki Praneet C, Patel Aman M, Huang Lily, Turner Gavin, Haleem Afash, Brant Jason A, Brody Robert M, Carey Ryan M

机构信息

Sidney Kimmel Medical College Thomas Jefferson University Philadelphia Pennsylvania USA.

Rutgers New Jersey Medical School Newark New Jersey USA.

出版信息

Laryngoscope Investig Otolaryngol. 2025 Oct 7;10(5):e70267. doi: 10.1002/lio2.70267. eCollection 2025 Oct.

DOI:10.1002/lio2.70267

PMID:41064576

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12501767/

Abstract

OBJECTIVE

To investigate the impact of clinical surveillance, primary radiotherapy, and primary surgery on overall survival (OS) in laryngeal carcinoma in situ (Cis).

METHODS

The 2006-2020 National Cancer Database was queried for adults with a biopsy-proven diagnosis of laryngeal Cis. Multivariable binary logistic and Cox proportional hazards regression models were implemented.

RESULTS

Of 3567 unique patients satisfying inclusion criteria, 514 (14.4%) underwent clinical surveillance, 1074 (30.1%) underwent primary radiotherapy, and 1979 (55.5%) underwent primary surgery. Receiving treatment at an academic/research facility was associated with higher odds of undergoing primary surgery compared to primary radiotherapy. Among 646 patients undergoing primary surgery with known pT classification and margins, 570 (76.6%) had pTis and NSM and 174 (23.4%) had pT1 and/or PSM. 5-year OS of clinical surveillance, primary radiotherapy, and primary surgery was 73%, 81%, and 86%, respectively ( < 0.001). Patients undergoing primary surgery with invasive or residual disease (i.e., pT1 and/or PSM) had similar 5-year OS as those without (84% vs. 88%, = 0.057). Compared with primary radiotherapy, clinical surveillance (aHR 1.29, 95% CI 1.06-1.57, = 0.003) was associated with worse OS, and primary surgery (aHR 0.80, 95% CI 0.69-0.92, = 0.003) was associated with higher OS.

CONCLUSION

Primary surgery is associated with higher OS than clinical surveillance and primary radiotherapy among patients with laryngeal Cis.

LEVEL OF EVIDENCE

摘要

目的

探讨临床监测、原发灶放疗和原发灶手术对原位喉癌（Cis）总生存期（OS）的影响。

方法

在2006 - 2020年国家癌症数据库中查询经活检证实为喉Cis的成人患者。采用多变量二元逻辑回归和Cox比例风险回归模型。

结果

在3567例符合纳入标准的患者中，514例（14.4%）接受临床监测，1074例（30.1%）接受原发灶放疗，1979例（55.5%）接受原发灶手术。与原发灶放疗相比，在学术/研究机构接受治疗的患者接受原发灶手术的几率更高。在646例已知pT分类和切缘情况的接受原发灶手术的患者中，570例（76.6%）为pTis且切缘阴性（NSM），174例（23.4%）为pT1和/或切缘阳性（PSM）。临床监测、原发灶放疗和原发灶手术的5年总生存率分别为73%、81%和86%（P<0.001）。有浸润性或残留疾病（即pT1和/或PSM）的接受原发灶手术的患者与无此类情况的患者5年总生存率相似（84%对88%，P = 0.057）。与原发灶放疗相比，临床监测（调整后风险比[aHR]1.29，95%置信区间[CI]1.06 - 1.57，P = 0.003）与更差的总生存期相关，而原发灶手术（aHR 0.80，95% CI 0.69 - 0.92，P = 0.003）与更高的总生存期相关。