Kashiwamura M, Fukuda S, Maguchi S, Higuchi E, Inuyama Y
Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo.
Nihon Jibiinkoka Gakkai Kaiho. 1995 Feb;98(2):254-9. doi: 10.3950/jibiinkoka.98.254.
Recently, therapy for laryngeal carcinoma has been becoming established, particularly in the early stage. The prognosis of laryngeal carcinoma is said to be better than that of other head and neck carcinomas. Laryngeal carcinoma is divided into 3 subtypes, supraglottic, glottic and subglottic, according to origin. We analyzed the subglottic carcinomas diagnosed and treated in our department between 1972 and 1990. During that period we treated 515 cases of laryngeal carcinoma, 204 cases of the supraglottic type, 284 cases of the glottic type, and 27 cases (5.2%) of the subglottic type. The 5-year survival rate in subglottic carcinoma was 44% (T1: 83%, T2:55%, T3: 17%, T4: 0%), worse than in the other types of laryngeal carcinoma. We think that there were 2 main reasons for the worse prognosis. The first was their high rate of local recurrence after radiation therapy particularly in the early stage. Although 15 T1 and T2 patients who received full dose (65Gy) radiotherapy had a complete response, 8 patients developed local recurrence. The results of the salvage operation were good in T1 cases, but were followed by death because of metastasis or second recurrence in 2 of the 3 T2 patients. The second reason for the worse prognosis appeared to be metastasis in the advanced cases. Five (50%) T3 and T4 patients developed metastasis to the lung, mediastinum and cervical lymph nodes, resulting in death. Thus, we believe that the main therapy for subglottic carcinoma, except T1, should be surgery to obtain a better outcome, and that adjuvant chemotherapy after irradiation or neck (paratracheal) dissection with total laryngectomy should be performed in advanced cases.
近年来，喉癌的治疗方法已逐渐确立，尤其是在早期阶段。据说喉癌的预后比其他头颈癌要好。喉癌根据起源部位分为3个亚型，即声门上型、声门型和声门下型。我们分析了1972年至1990年间在我科诊断和治疗的声门下型癌。在此期间，我们共治疗了515例喉癌患者，其中声门上型204例，声门型284例，声门下型27例（占5.2%）。声门下型癌的5年生存率为44%（T1期：83%，T2期：55%，T3期：17%，T4期：0%），比其他类型的喉癌差。我们认为预后较差有两个主要原因。第一个原因是放疗后局部复发率高，尤其是在早期。虽然15例接受全剂量（65Gy）放疗的T1和T2期患者达到了完全缓解，但仍有8例出现局部复发。T1期患者挽救手术的效果良好，但3例T2期患者中有2例术后因转移或二次复发死亡。预后较差的第二个原因似乎是晚期病例发生转移。5例（50%）T3和T4期患者出现肺、纵隔和颈部淋巴结转移，导致死亡。因此，我们认为，除T1期外，声门下型癌的主要治疗方法应为手术，以获得更好的疗效，对于晚期病例，应在放疗后或行颈部（气管旁）清扫及全喉切除术后进行辅助化疗。
