新辅助化疗联合环甲膜固定的环状软骨上部分喉切除术治疗T3-T4期晚期喉内癌：5年肿瘤学结果
Neo-adjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidopexy for advanced endolaryngeal carcinoma classified as T3-T4: 5-year oncologic results.
作者信息
Laccourreye O, Brasnu D, Biacabe B, Hans S, Seckin S, Weinstein G
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Laënnec Hospital, Assistance Publique des Hôpitaux de Paris, University Paris V, France.
出版信息
Head Neck. 1998 Oct;20(7):595-9. doi: 10.1002/(sici)1097-0347(199810)20:7<595::aid-hed3>3.0.co;2-k.
BACKGROUND
Historically, total laryngectomy with voice-prosthesis insertion and near-total laryngectomy were the surgical options advocated for advanced supraglottic and transglottic tumors classified as T3-T4.
METHODS
The present retrospective study reviewed our experience with neo-adjuvant chemotherapy and supracricoid partial laryngectomy with cricohyoidopexy (SCPL-CHP) in a series of 60 patients with an isolated, untreated, advanced supraglottic/transglottic invasive squamous cell carcinoma classified as T3-T4.
RESULTS
The Kaplan-Meier 5-year actuarial survival, local failure, nodal failure, and distant metastasis estimates were 72.7%, 8.3%, 9.2%, and 9.8%, respectively. Survival was significantly reduced in patients with nodal failure (p = .001) and distant metastasis (p = .007). Overall, a 91.7% laryngeal preservation rate and a 98.3% local control rate were achieved.
CONCLUSION
Our report was a retrospective analysis and did not present a control group exclusively managed with SCPL-CHP. Therefore, we were unable to demonstrate that the use of neo-adjuvant chemotherapy prior to SCPL-CHP allowed for an increase in local control, laryngeal preservation, and survival. However, the use of neo-adjuvant chemotherapy allowed for remobilization of a fixed arytenoid cartilage in 10 patients who thus became amenable to SCPL-CHP. The key role of neo-adjuvant chemotherapy in this series was as a prognostic indicator for suitability for SCPL-CHP in the case of supraglottic-transglottic tumor with arytenoid cartilage fixation. Our data also supported the notion that SCPL-CHP is a valid alternative to total laryngectomy with voice prosthesis insertion and near-total laryngectomy in selected patients with a previously untreated supraglottic/transglottic invasive squamous cell carcinoma classified as T3-T4. Furthermore, the successful use (in terms of surgical outcome, laryngeal preservation, and survival) of SCPL-CHP after neo-adjuvant chemotherapy suggested that laryngeal organ-preservation strategies, in advanced endolaryngeal transglottic and/or supraglottic invasive squamous cell carcinoma, should not be limited to the use of laryngeal radiotherapy after neo-adjuvant chemotherapy.
背景
从历史上看，对于分类为T3 - T4的晚期声门上和声门跨区肿瘤，全喉切除术加发音假体植入术和次全喉切除术是提倡的手术选择。
方法
本回顾性研究回顾了我们对60例孤立的、未经治疗的、晚期声门上/声门跨区浸润性鳞状细胞癌（分类为T3 - T4）患者进行新辅助化疗和环状软骨上部分喉切除术加环舌骨固定术（SCPL - CHP）的经验。
结果
Kaplan - Meier法计算的5年实际生存率、局部失败率、区域淋巴结失败率和远处转移率分别为72.7%、8.3%、9.2%和9.8%。区域淋巴结失败（p = 0.001）和远处转移（p = 0.007）的患者生存率显著降低。总体而言，实现了91.7%的喉保留率和98.3%的局部控制率。
结论
我们的报告是一项回顾性分析，没有提供仅采用SCPL - CHP治疗的对照组。因此，我们无法证明在SCPL - CHP之前使用新辅助化疗能提高局部控制率、喉保留率和生存率。然而，新辅助化疗使10例固定的杓状软骨活动，从而适合进行SCPL - CHP。在本系列中，新辅助化疗的关键作用是作为声门上 - 声门跨区肿瘤伴杓状软骨固定患者是否适合SCPL - CHP的预后指标。我们的数据还支持了这样一种观点，即对于先前未经治疗的分类为T3 - T4的声门上/声门跨区浸润性鳞状细胞癌患者，SCPL - CHP是全喉切除术加发音假体植入术和次全喉切除术的有效替代方案。此外，新辅助化疗后SCPL - CHP的成功应用（在手术结果方面、喉保留和生存方面）表明，在晚期喉内声门跨区和/或声门上浸润性鳞状细胞癌中，喉器官保留策略不应局限于新辅助化疗后使用喉部放疗。
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