CO_2激光声带切除术后复发相关因素分析

Prognostic factors of local recurrence after endoscopic laser cordectomy for early glottic carcinoma

目的探讨早期声门癌经CO2激光手术后,其复发相关因素对患者预后的影响。方法回顾经CO2激光治疗声门癌患者76例病历资料,所有新鲜标本标记切缘,肉眼切缘2 mm,甲醛液中固定。石蜡包埋,HE染色,光镜观察。Kaplan–Meier法计算生存率和无瘤生存率,单因素分析应用log rank test方法。结果局部复发11例(14.5%),5年生存率92.0%,5年无瘤生存率81.9%,喉保存率96.1%。单因素分析显示,前联合受侵和甲杓肌受侵导致5年无瘤生存率降低(P=0.002,P=0.001),而病理切缘阳性并不影响5年无瘤生存率(P=0.065)。结论前联合受侵和甲杓肌受侵将增加CO2激光治疗早期声门癌术后复发风险,切缘阳性并不影响5年无瘤生存率,对术后切缘阳性患者采取密切随访观察,避免过度治疗。

Objective To assess the prognostic factors of local recurrence after endoscopic laser cordectomy for early glottic carcinoma. Methods Data of 76 patients with early glottic carcinoma （T1a,T1b,T2）, who were treated with endoscopic laser cordectomy between January 2000 to February 2012 at single institution, were retrospectively analyzed. Surgical margins were set at about 2mm and marked. Surgical specimens were fixed in 10% buffered formalin and embedded with paraffin. Sections were stained using hematoxylin-eosin for pathologic examination. Overall survival and disease-free survival were estimated using the Kaplan-meier method. The univariate analyses of prognosis factors with impact on disease-free survival were assessed with the log-rank test. Results The 5 year overall survival, disease-free survival, and laryngeal preservation were 92.0%, 81.9%, and 96.1% respectively. Univariate analysis revealed that anterior commissure involvement and thyroarytenoid muscle invasion exerted a significant impact on disease-free survival. There was no significant difference in disease-free survival according to the status of surgical margin. Conclusion The anterior commissure involvement and thyroarytenoid muscle invasion increase the risk of local recurrence for endoscopic laser cordectomy. The positive margin does not show any influence on 5 year disease-free survival, however, close surveillance is required to avoid over-treatment.