单纯放疗或单纯手术治疗早期声门型喉癌

Comparison of radiotherapy and surgery for 456 consecutive patients with early glottic cancer

目的分析早期声门型喉癌单纯手术和单纯放疗的治疗结果和预后因素。方法T1～T2N0M0期声门型喉癌患者456例,其中136人行单纯手术(手术组),320例接受单纯放疗(单放组)。结果手术组和单放组的5、10年总生存率(OS)分别为95.2%和84.8%、89.1%和76.5%(P<0.01)。手术组和单放组的5年无病生存率(DFS)分别为86.6%和80.6%(P=0.250)。手术组和单放组首程治疗后的5年局部控制率(LC)分别为86.2%和81.9%(P=0.420)。全组中80例出现局部区域复发或远地转移,其中70例出现喉部复发,57例进行了挽救性手术。单放组喉保留率显著高于手术组,分别为91.6%和83.9%(P=0.010)。Cox多因素回归分析表明,年龄大、声带活动受限和治疗年代远是影响OS的不良预后因素,前联合受侵是DFS和LC的不良预后因素,前联合受侵和声带活动受限是癌症相关生存率(CSS)的不良预后因素。结论早期声门型喉癌单纯放疗与单纯手术的DFS、LC相同,而且喉保留率高于手术组。影响各项生存率和局部控制率的主要因素为年龄大、声带活动受限、治疗年代久远和前联合受侵。

Objective To compare the treatment results between surgery alone and irradiation alone for patients with early glottic cancer (T1-T2N0M0) and to analyze the prognostic factors. Methods From Aug. 1958 to Dec. 1994, 456 consecutive patients with T1-T2N0M0 (UICC 1997) squamous cell carcinoma of the glottis were treated either by surgery alone (n =136) or radiotherapy alone (n =320).Results The 5-and 10-year overall survival rates (OS) for surgery group (S group) and radiotherapy group (RT group) were 95.2% , 89.1%, 84.8%, 76.5%(P<0.01),respectively. It was comparable for 5-year disease free survival rate (DFS) and local control rate (LC) which were 86.6%,80.6%(P=0.250); 86.2%, 81.9%(P=0.420). Fifty-seven out of 70 with primary recurrence underwent salvage surgery, and the final 5-y LC rate was 96.5%(S group)and 96.4%(RT group), respectively. The final larynx-preservation rate was significantly higher in RT group than in S group ( χ2 =9.02,P=0.010). Multivariate analysis revealed older age, glottis impair and early treatment time were adverse prognostic factors for OS, the anterior commissure involvement influenced the DFS and LC dramatically. Elder age indicated the high probability to develop the second primary tumor.Conclusions Radiotherapy alone provides similar results of LC, DFS, CSS, higher larynx preservation, and probably higher quality of life as compared to surgery alone. Older age, glottis impair, early treatment time and anterior commissure involvement are the independent adverse prognostic factors for early glottic carcinoma.