Blackwell K E, Calcaterra T C, Fu Y S
Department of Surgery, University of California-Los Angeles School of Medicine, USA.
Ann Otol Rhinol Laryngol. 1995 Aug;104(8):596-602. doi: 10.1177/000348949510400802.
A retrospective analysis was undertaken of 65 patients with long-term follow-up for laryngeal squamous dysplasia. Based on the degree of dysplasia demonstrated on initial biopsy, 0 of 6 patients showing hyperkeratosis without dysplasia, 3 of 26 patients (12%) showing mild dysplasia, 5 of 15 patients (33%) showing moderate dysplasia, 4 of 9 patients (44%) showing severe dysplasia, and 1 of 9 patients (11%) showing carcinoma in situ eventually progressed to invasive carcinoma. An analysis was made of the impact of various treatment modalities in 33 patients demonstrating moderate dysplasia, severe dysplasia, or carcinoma in situ. Invasive carcinoma developed in 10 of 21 patients (48%) treated endoscopically and 0 of 12 patients treated by more aggressive therapy, including external beam radiotherapy, partial laryngectomy, or total laryngectomy. Of the patients in the endoscopic therapy group who developed invasive carcinoma, all were salvaged successfully. The overall rate of laryngeal preservation was 15 of 21 patients (71%) in the endoscopic treatment group and 11 of 12 patients (92%) in the aggressive treatment group. This difference is not statistically significant. We conclude that there is a moderately high rate of progression to invasive carcinoma in patients undergoing repeated endoscopic therapy for intraepithelial neoplasms of the larynx. However, with close, long-term follow-up, patients undergoing endoscopic therapy have an overall outcome similar to that in patients treated with partial laryngectomy or radiotherapy prior to developing invasive disease.
对65例长期随访的喉鳞状上皮发育异常患者进行了回顾性分析。根据初次活检显示的发育异常程度，6例显示角化过度而无发育异常的患者中0例进展，26例显示轻度发育异常的患者中有3例（12%）进展，15例显示中度发育异常的患者中有5例（33%）进展，9例显示重度发育异常的患者中有4例（44%）进展，9例显示原位癌的患者中有1例（11%）最终进展为浸润性癌。对33例显示中度发育异常、重度发育异常或原位癌的患者的各种治疗方式的影响进行了分析。接受内镜治疗的21例患者中有10例（48%）发生浸润性癌，而接受更积极治疗（包括外照射放疗、部分喉切除术或全喉切除术）的12例患者中0例发生浸润性癌。在内镜治疗组中发生浸润性癌的患者中，所有患者均成功挽救。内镜治疗组21例患者中有15例（71%）保留了喉，积极治疗组12例患者中有11例（92%）保留了喉。这种差异无统计学意义。我们得出结论，接受反复内镜治疗的喉上皮内瘤变患者进展为浸润性癌的发生率中等偏高。然而，通过密切、长期的随访，接受内镜治疗的患者在发生浸润性疾病之前的总体结局与接受部分喉切除术或放疗的患者相似。
