喉垂直部分切除术治疗声门型喉癌的临床疗效分析
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复旦大学附属眼耳鼻喉科医院

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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)。


Clinical outcome of vertical partial laryngectomy in treatment of patients with glottic carcinoma
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Eye and ENT Hospital, Fudan University

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    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,以及探讨影响预后的危险因素。 方法:回顾性分析2005年1月至2010年12月在本中心接受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,包括总存率(OS)和无病生存率(DFS),利用Cox回归模型分析影响预后的因素。 结果:本组研究男性患者537例(98.0%),女性11例(2.0%),平均年龄为59.0±9.4岁(范围:34–89岁)。T1期169例(30.8%),T2期316例(57.7%),T3期63例(11.5%)。3年,5年和10年的OS分别为96.5%,92.1%和83.3%;3年,5年和10年的DFS分别为93.2%,88.0%和79.6%。发现较晚T分期患者的生存率较差(p<0.001),较大肿瘤面积患者的生存率较差(p<0.001),在T2期和T3期内较大肿瘤面积的患者的生存率较差(p<0.05)。回归模型分析发现影响患者OS和DFS的因素包括较晚T分期,较大肿瘤面积和年龄大于70岁(p<0.05)。 结论:本研究系统的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,判断患者的预后考虑T分期,肿瘤体积和年龄。

    Abstract:

    Objective The aim of this study was to analyze the long term clinical outcomes of vertical partial laryngectomy (VPL) in management of patients with glottic carcinoma, and to explore potential prognostic factor on survival outcomes. Methods In this series, records of 548 consecutive glottic carcinoma patients from Jan. 2005 to Dec. 2010 were retrospectively reviewed. The long term clinical outcomes including overall survival (OS) and disease-frees survival (DFS) of patients who underwent primary VPL were evaluated. Cox regression models were used to assess the prognostic agents that may predict survival outcomes. Results In all, 537 (98.0%) patients were male and 11 (2.0%) were female, with a mean age of 59.0±9.4 years (range: 34 - 89 years). One hundred and sixty-nine patients (30.8%) were at T1 stage, 316 patients (57.7%) were at T2 stage, 63 patients (11.5%) were at T3 stage when confirmed to be 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 models detected that higher T stages, greater tumor area and older age were predictive factors for patients with glottic carcinoma. Conclusion This retrospective study indicates that VPL treatment with excellent survival outcome is a reliable procedure and may be considered as standard therapy 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 survivals in patients with glottic carcinoma.

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  • 收稿日期:2022-11-30
  • 最后修改日期:2023-01-17
  • 录用日期:2023-01-19
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