Higuchi E, Iizuka K, Shouda H, Takeichi N
Department of Otorhinolaryngology, Kushiro City Hospital.
Nihon Jibiinkoka Gakkai Kaiho. 1996 Mar;99(3):385-94. doi: 10.3950/jibiinkoka.99.385.
An analysis of 74 patients with laryngeal cancer treated between February 1985 and July 1995 is presented. Their mean age was 64 years, and the male to female ratio was 14:1. There were 48 cases of the glottic type, 21 cases of the supraglottic type, 2 cases of the subglottic type, and 3 cases of the transglottic type. Histopathologically, there were 72 cases of squamous cell carcinoma and 2 cases of mucoepidermoid carcinoma. Cervical lymph node metastasis was detected in 12 cases (16%). The incidence of cervical lymph node metastasis in supraglottic carcinoma was significantly higher (p < 0.01) than that in glottic carcinoma. There were 12 cases of second primary cancers. The location of the lesions was as follows: lung, 4; esophagus, 2; stomach, 2; prostate, 2; liver, 1; and gingiva, 1. Radical radiotherapy was performed in 52 cases; the local control rate was 98%, and the recurrence rate was 20%. Combined radiotherapy and total laryngectomy or laryngectomy alone was performed in 23 cases, and the recurrence rate was 23%. The recurrence rate for glottic carcinoma after initial therapy was 13%, supraglottic carcinoma 38%, subglottic carcinoma 100% and transglottic carcinoma 33%. Five-year total survival and cause-specific survival rate were 69% and 82%, respectively. Five-year cause-specific survival rates according to subsite were 95% for glottic carcinoma, 69% for supraglottic carcinoma, 0% for subglottic carcinoma, and 50% for transglottic carcinoma. The survival rate in glottic carcinoma was significantly better (p < 0.05) than in supraglottic carcinoma. These results led us to establish the following guidelines for the treatment of laryngeal cancer: for T1 or T2 cases of the glottic type, radiotherapy is recommended first; for T3 or T4 cases of the glottic type, total laryngectomy after radiation therapy is recommended; for T1 or T2N0 cases of the supraglottic type, radiotherapy is recommended first; for T2N(+) or T3 or T4 cases of the supraglottic type, total laryngectomy after radiation therapy is recommended. If cervical lymph node metastasis is presently, neck dissection is necessary.
本文对1985年2月至1995年7月间收治的74例喉癌患者进行了分析。他们的平均年龄为64岁，男女比例为14:1。声门型48例，声门上型21例，声门下型2例，跨声门型3例。组织病理学检查，鳞状细胞癌72例，黏液表皮样癌2例。12例（16%）检测到颈部淋巴结转移。声门上癌颈部淋巴结转移发生率显著高于声门癌（p<0.01）。有12例第二原发癌。病变部位如下：肺4例；食管2例；胃2例；前列腺2例；肝1例；牙龈1例。52例行根治性放疗，局部控制率为98%，复发率为20%。23例行放疗联合全喉切除术或单纯全喉切除术，复发率为23%。声门癌初始治疗后的复发率为13%，声门上癌为38%，声门下癌为100%，跨声门癌为33%。5年总生存率和病因特异性生存率分别为69%和82%。根据亚部位划分的5年病因特异性生存率，声门癌为95%，声门上癌为69%，声门下癌为0%，跨声门癌为50%。声门癌的生存率显著优于声门上癌（p<0.05）。这些结果使我们制定了以下喉癌治疗指南：对于声门型T1或T2病例，建议首选放疗；对于声门型T3或T4病例，建议放疗后行全喉切除术；对于声门上型T1或T2N0病例，建议首选放疗；对于声门上型T2N(+)或T3或T4病例，建议放疗后行全喉切除术。如果目前存在颈部淋巴结转移，则需要行颈部清扫术。
