不同肿瘤扩展模式对T3期声门型喉癌手术治疗的预后分析  

Prognostic impact of different tumor invasion patterns in the surgical treatment of T3glottic laryngeal cancer

作　　者：凌志明 胡国华[1] 王志海[1] 马玮 王晓强[1] 朱江[1] 曾泉[1] LING Zhiming;HU Guohua;WANG Zhihai;MA Wei;WANG Xiaoqiang;ZHU Jiang;ZENG Quan(Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院耳鼻咽喉头颈外科,重庆400016

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第12期998-1004,共7页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：重庆市科卫联合医学科研项目(No:2021MSXM053)。

摘　　要：目的:研究不同肿瘤扩展模式在T3期声门型喉癌手术治疗中的预后影响。方法:对91例T3期声门型喉癌患者的临床资料进行了回顾性分析。结果:91例患者中,前侵犯58例(63.7%),后侵犯33例(36.3%),后侵犯与环状软骨背板(P<0.001)、杓状软骨(P=0.001)、声门下(P=0.001)侵犯显著相关。部分喉切除组与全喉切除组生存结局差异无统计学意义;部分喉切除组中前侵犯肿瘤5年无病生存率优于后侵犯肿瘤(HR:4.681,95%CI 1.337~16.393,P=0.016),声门下侵犯与较差的5年局部区域无复发生存率相关(HR:3.931,95%CI 1.054~14.658,P=0.041)。同时,还发现环状软骨背板侵犯是部分喉切除术后发生喉狭窄的独立危险因素(HR:11.67,95%CI 1.89~71.98,P=0.008)。结论:经选择的部分喉切除术较全喉切除术同样能获得良好的肿瘤学结果。后侵犯和声门下侵犯是T3期声门型喉癌部分喉手术复发的独立预后因素,环状软骨背板侵犯与部分喉术后喉狭窄相关。应进一步细分喉癌患者的肿瘤侵犯模式,以选择更为个体化的治疗方案。Objective:To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3glottic laryngeal cancer.Methods:A retrospective analysis was conducted on the clinical data of 91patients with T3glottic laryngeal cancer.Results:Among the 91patients,58cases(63.7%)had anterior invasion and 33cases(36.3%)had posterior invasion.The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage(P<0.001),arytenoid cartilage(P=0.001),and subglottic region(P=0.001).There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group.But in the partial laryngectomy group,the 5-year disease-free survival(DFS)of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors(HR:4.681,95%CI 1.337-16.393,P=0.016),and subglottic invasion was associated with worse loco-regional recurrence-free survival(LRRFS)(HR:3.931,95%CI 1.054-14.658,P=0.041).At the same time,we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients(HR:11.67,95%CI 1.89-71.98,P=0.008).Conclusion:Compared with total laryngectomy,selected partial laryngectomy can also achieve favorable oncological outcomes.Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer,and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis.The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.

关 键 词：喉肿瘤 肿瘤侵犯 喉切除术 预后 

分 类 号：R739.65[医药卫生—肿瘤]