喉垂直部分切除术治疗声门型喉癌的临床疗效分析  

Clinical outcomes of vertical partial laryngectomy in glottic carcinoma

作　　者：龚洪立 施勇 陶磊 张明 吴海涛 曹鹏宇 周健 周梁 GONG Hongli;SHI Yong;TAO Lei;ZHANG Ming;WU Haitao;CAO Pengyu;ZHOU Jian;ZHOU Liang(Department of Otolaryngology Head and Neck Surgery,Eye&ENT Hospital of 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：《中国耳鼻咽喉颅底外科杂志》2023年第2期13-18,共6页Chinese Journal of Otorhinolaryngology-skull Base 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：目的分析喉垂直部分切除术(VPL)治疗声门型喉癌的远期临床疗效,探讨影响患者预后的危险因素。方法回顾性分析2005年1月—2010年12月接受VPL治疗的548例声门型喉癌患者的临床资料,评价手术治疗后的疗效,包括总生存率(OS)和无病生存率(DFS),利用Cox回归模型分析影响患者预后的因素。结果本组研究患者,其中男537例(98.0%),女11例(2.0%);年龄34~89岁,平均年龄(59.0±9.4)岁。T1期169例(30.8%),T2期316例(57.7%),T3期63例(11.5%)。3、5年和10年的OS分别为96.5%,92.1%和83.3%;3、5年和10年的DFS分别为93.2%,88.0%和79.6%。研究发现T分期越晚患者的生存率越差(P<0.001),肿瘤面积越大的患者生存率越差,在T2期和T3期内肿瘤面积越大的患者其生存率越差(P<0.05)。回归模型分析发现影响患者OS和DFS的因素包括T分期、肿瘤面积和年龄>70岁。结论本研究分析了大样本量的声门型喉癌接受VPL的远期临床疗效,患者获得了较理想的生存率。对于喉部支撑喉镜暴露欠佳的早期和经选择的T3期声门型喉癌可选择VPL,判断患者的预后情况主要考虑T分期、肿瘤体积和年龄。Objective To analyze the long term clinical outcomes of vertical partial laryngectomy(VPL)in management of patients with glottic carcinoma,and to explore potential prognostic factors on survival outcomes.Methods Clinical data of 548 glottic carcinoma patients underwent VPL in our department from Jan 2005 to Dec 2010 were retrospectively studied.The long-term clinical outcomes including overall survival(OS)and disease free survival(DFS)were evaluated.Cox regression models were used to analyze the factors impacting the prognosis.Results Of all cases,537(98.0%)were male and 11(2.0%)were female,with an average age of(59.0±9.4)years(range:34 to 89 years).As for the T stage,169 patients(30.8%)were at T1,316(57.7%)at T2,63(11.5%)at T3 of glottic carcinoma.The 3-,5-and 10-year OS rates were 96.5%,92.1%and 83.3%,respectively.And the 3-,5-and 10-year DFS rates were 93.2%,88.0%and 79.6%,respectively.Patients with advanced T stage and greater tumor area experienced inferior survival outcomes(P<0.001).Regarding patients with the same T stage of T2 or T3,those with greater tumor area had poorer survival outcomes(P<0.05).Cox regression model analyses revealed that T stage and area of tumor as well as patient’s age were predictive factors for the prognosis of glottic carcinoma.Conclusions With excellent survival outcome,VPL is a reliable procedure and may be considered for T1-T2 and selected T3 glottic carcinoma patients with poor larynx exposure.Advanced T stage,greater tumor area and age older than 70 years are risk factors of survival in patients with glottic carcinoma.

关 键 词：声门型喉癌 喉垂直部分切除术 总生存率 无病生存率 

分 类 号：R739.65[医药卫生—肿瘤]