气管切开对喉癌并发喉梗阻患者远期临床疗效的影响  

Long-term clinical outcomes of preoperative tracheotomy in the management of upper airway obstruction of laryngeal carcinoma

作　　者：龚洪立 周梁 陶磊 张明 吴海涛 李采 吴春萍 薛继尧 周健 GONG Hongli;ZHOU Liang;TAO Lei;ZHANG Ming;WU Haitao;LI Cai;WU Chunping;XUE Jiyao;ZHOU Jian(Department of Otolaryngology Head and Neck Surgery,Eye&ENT Hospital,Fudan University,Shanghai,200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科,上海200031

出　　处：《中国耳鼻咽喉头颈外科》2022年第5期273-277,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：上海市申康医院发展中心临床研究关键支撑项目(SHDC2020CR6011);上海市科学技术委员会科技支撑项目(19411961300);上海市科学技术委员会“科技创新行动计划”医学创新研究专项项目(21Y11900100);上海市“医苑新星”青年医学人才培养资助项目(沪卫计人事[2019]72号)。

摘　　要：目的 分析气管切开是否影响喉癌并发喉梗阻患者总生存率(overall survival,OS)和无病生存率(disease free survival,DFS),并探索潜在的原因。方法 本研究纳入2005年1月~2010年12月共695例T3~T4级喉癌患者,喉梗阻需先行气管切开再予喉癌根治性治疗。回顾性分析临床和随访数据,倾向性评分匹配(propensity score matching,PSM)去除混杂偏移因素,按照1∶1选择气管切开组(简称气切组)患者和对照组。Logistic模型分析与喉梗阻气管切开相关的变量,Cox模型分析影响喉癌OS和DFS的变量。结果 本组男性674例(97.0%),女性21例(3.0%),平均年龄60.9岁。142例(20.4%)患者因喉梗阻行气管切开,T3级气管切开比例为12.9%,低于T4级的45.1%。PSM校正数据后,气切组5年、10年的OS分别为47.5%和36.4%,5年、10年的DFS分别为43.4%和34.4%。对照组5年、10年的OS分别为59.7%和45.8%,5年、10年的DFS分别为52.4%和42.6%。气切组OS和DFS较对照组降低。气切组肿瘤直径和肿瘤面积大于对照组(直径:3.6 cm vs 2.8 cm^(2)面积:10.4 cm^(2)vs 6.9 cm^(2))。较晚T分级、较大肿瘤直径和肿瘤面积三个变量和喉梗阻存在相关性,是需要气管切开的危险因素。单因素分析发现喉梗阻行气管切开是影响OS的因素,但多因素分析无统计学意义,此外局部区域复发、T分级、肿瘤直径、肿瘤面积四个变量均是影响喉癌患者OS和DFS的独立危险因素。结论 因喉梗阻行气管切开的喉癌患者生存率下降,较晚的T分级与较大的实体肿瘤均和喉梗阻相关,是影响生存率的危险因素,而气管切开仅作为解除喉梗阻的治疗方案,不是危险因素。OBJECTIVE To evaluate the influence of preoperative tracheotomy on overall survival(OS) and disease free survival(DFS) in laryngeal carcinoma patients with upper airway obstruction,and to explore the potential reasons.METHODS We retrospectively analyzed 695 consecutive laryngeal carcinoma patients with T3-T4 stages from 2005 to 2010.Patients with laryngeal obstruction received tracheotomy before definitive therapy.The clinical variables were delineated,and patient numbers with 134 cases and 134 control patients were adjusted by propensity score matching(PSM).The association of clinical variables with preoperative tracheotomy was assess by logistic regression models,and the influence of potential variables on OS and DFS of laryngeal carcinoma was evaluated by Cox regression models.RESULTS Our cohort consisted of 674 (97.0%) men and 21 women(3.0%),with mean age of 60.9 years old.One hundred and forty-two patients(20.4%) with laryngeal obstruction required preoperative tracheotomy.The tracheotomy rate of 12.9% in T3 stage was lower than those of patients with T4 stage(45.1%).The patient numbers of two groups with or without tracheotomy were adjusted by PSM matching,and 134 patients were obtained in each group.The 5-year and 10-year OS rates of tracheotomy group were 47.5% and 36.4%,respectively,and the 5-year and 10-year DFS rates were 43.4% and 34.4%,respectively.The 5-year and 10-year OS rates of control group were 59.7% and 45.8%,respectively,and the 5-year and 10-year DFS rates were 52.4% and 42.6%,respectively.The OS and DFS rates of tracheotomy group were lower compared with control group,and the mean tumor diameter and tumor area of tracheotomy group were greater than control group(diameter:3.6 cm vs 2.8 cm^(2)area:10.4 cm^(2) vs 6.9 cm^(2)).Advanced T stage,greater tumor diameter,and greater tumor area were correlated with preoperative tracheotomy,and these three variables were independent risk factors for tracheotomy intervention.Preoperative tracheotomy was risk factor for OS using univariate Cox regressio

关 键 词：喉肿瘤 气管切开术 治疗结果 喉梗阻 生存率 肿瘤体积 

分 类 号：R739.65[医药卫生—肿瘤]