Kaplan M J, Johns M E, Clark D A, Cantrell R W
Cancer. 1984 Jun 15;53(12):2641-8. doi: 10.1002/1097-0142(19840615)53:12<2641::aid-cncr2820531212>3.0.co;2-h.
The treatment of 336 patients with squamous cell carcinoma of the glottic larynx seen at the University of Virginia Medical Center from 1960 through 1977 was reviewed. Two hundred eighty-five patients form the basis of this report. Patients were grouped by stage and by other prognostic factors. Five-year actuarial survival, recurrences, salvage therapy, complications, second primaries, and incidence in patients younger than 45-years-old were examined. The actuarial 5-year survivals are Stage I, 96%; Stage II, 88%; Stage III, 65%; and Stage IV, 57%. Early glottic carcinoma responded equally well to radiation therapy or surgery, and mortality from intercurrent disease was more common than death from glottic carcinoma. Anterior commissure involvement was not found to significantly decrease prognosis in Stage I disease. Within Stage II, patients with impaired true cord mobility had a significantly decreased survival, 71%, versus 93% for Stage II carcinoma with mobile cords. Surgery was superior to irradiation when cord mobility was impaired or fixed. Surgical salvage was successful in 70% of cases when the cords were originally mobile but 11% when cord motion had been impaired or fixed. Patients younger than age 45 years presented with more advanced disease, but by stage, treatment response did not differ from the remaining older group. Based on this review and from data reported in the literature, the authors recommend curative radiation therapy in patients with glottic carcinoma where the vocal cords are fully mobile. When cord mobility is impaired or fixed, the inclusion of surgery in the initial management results increased survival over irradiation alone. Recognizing that glottic carcinoma is often part of a multisystem disease, individualization of treatment is especially important in these advanced tumors.
回顾了1960年至1977年在弗吉尼亚大学医学中心就诊的336例声门型鳞状细胞癌患者的治疗情况。本报告基于285例患者。患者按分期和其他预后因素分组。研究了5年精算生存率、复发情况、挽救治疗、并发症、第二原发肿瘤以及45岁以下患者的发病率。精算5年生存率分别为：I期96%；II期88%；III期65%；IV期57%。早期声门癌对放射治疗或手术的反应同样良好，并发疾病导致的死亡率比声门癌导致的死亡更为常见。在I期疾病中，未发现前联合受累会显著降低预后。在II期内，声带活动受限的患者生存率显著降低，为71%，而声带活动正常的II期癌患者生存率为93%。当声带活动受限或固定时，手术优于放疗。当声带最初活动时，手术挽救成功率为70%，但当声带活动受限或固定时，成功率为11%。45岁以下的患者所患疾病更为晚期，但按分期来看，治疗反应与其他年龄较大的组并无差异。基于本综述以及文献报道的数据，作者建议对于声带活动完全正常的声门癌患者采用根治性放射治疗。当声带活动受限或固定时，初始治疗中加入手术可提高生存率，优于单纯放疗。认识到声门癌通常是多系统疾病的一部分，对于这些晚期肿瘤，治疗个体化尤为重要。
