Mittal B, Marks J E, Ogura J H
Cancer. 1984 Jan 1;53(1):151-61. doi: 10.1002/1097-0142(19840101)53:1<151::aid-cncr2820530127>3.0.co;2-x.
The cases of 152 patients with transglottic carcinoma were reviewed. There were 31% T2, 39% T3, and 30% T4 lesions. Twenty-six percent of patients had neck node metastases at initial presentation, and 19% with no neck dissection or radical irradiation to the neck subsequently developed neck metastases. Patients treated with voice conservation surgery +/- neck dissection +/- radiation (VCS +/- ND +/- R) had small transglottic carcinomas, whereas total laryngectomy +/- neck dissection +/- radiation (TL +/- ND +/- R) was used for patients with larger lesions. The reason for radiation alone (RA) was the patient's poor general condition or refusal of surgery. The total failure rate (primary, neck, and distant metastases) was 39%. Patients treated with TL +/- ND +/- R had fewer primary and stomal failures (12%) than those treated by VCS +/- ND +/- R (23%) and RA (33%), but ultimate failure after salvage treatment was the same (12%-13%). Sixty percent of patients treated with VCS and 67% with RA had their voices preserved. The major complication rate (overall, 16%) was highest in the group treated with VCS +/- ND +/- R. Five-year observed and adjusted survival for the entire group was 47% and 55%, respectively. The lower survival in the RA group was attributable to a high death rate from intercurrent disease. The incidence of second tumors was 14%. Unfavorable prognostic factors were older age, pretreatment tracheostomy, advanced stage and the presence of tumor in surgical specimen, and lymph nodes.
回顾了152例声门跨区癌患者的病例。T2病变占31%，T3病变占39%，T4病变占30%。26%的患者初诊时即有颈部淋巴结转移，19%未行颈部清扫或颈部根治性放疗的患者随后出现颈部转移。采用保留嗓音手术±颈部清扫±放疗（VCS±ND±R）治疗的患者为较小的声门跨区癌，而全喉切除术±颈部清扫±放疗（TL±ND±R）用于病变较大的患者。单纯放疗（RA）的原因是患者全身状况差或拒绝手术。总失败率（原发、颈部和远处转移）为39%。接受TL±ND±R治疗的患者原发和造口失败率（12%）低于接受VCS±ND±R治疗的患者（23%）和RA治疗的患者（33%），但挽救治疗后的最终失败率相同（12%-13%）。接受VCS治疗的患者中有60%、接受RA治疗的患者中有67%保留了嗓音。主要并发症发生率（总体为16%）在接受VCS±ND±R治疗的组中最高。整个组的5年观察生存率和校正生存率分别为47%和55%。RA组生存率较低归因于并发疾病导致的高死亡率。第二肿瘤的发生率为14%。不良预后因素包括年龄较大、治疗前气管切开、晚期以及手术标本中有肿瘤和淋巴结。
