声带白斑黏膜剥脱术复发及癌变的预后研究

On Prognosis of Recurrence and Canceration After Mucosal Exfoliation for Vocal Cord Leukoplakia

目的探讨影响声带白斑黏膜剥脱术的临床预后相关因素。方法回顾性分析1998年1月~2013年12月416例因声带白斑行黏膜剥脱术的临床资料,计算术后1、3、5年复发率和癌变率,并用COX单因素分析性别、年龄、吸烟、酗酒、白斑范围、组织病理与声带白斑术后复发、癌变的关系,筛选与复发、癌变相关的变量,进入多元COX回归分析模型。结果 416例黏膜剥脱术后声带白斑复发107例,癌变43例,其中1、3、5年复发率分别为9.4%、20.8%、26.0%,癌变率分别为1.9%、6.7%、10.2%。年龄、白斑范围、组织病理均被选入复发及癌变多元COX回归分析模型。多元COX回归分析结果表明:白斑范围、组织病理是影响声带白斑术后复发的预后因素;组织病理是影响声带白斑术后癌变的预后因素。结论声带白斑黏膜剥脱术后复发与白斑范围、组织病理相关,癌变与组织病理相关;组织病理为中度异型增生和重度异型增生的声带白斑为术后高风险复发、癌变组。

Objective To investigate the clinical prognosis of mucosal exfoliation for vocal cord leukoplakia. Methods A total of 416 cases of vocal cord leukoplakia treated by mucosal exfoliation from January 1998 to December 2013 were retrospectively analyzed. The ratios of recurrence and canceration at 1-,3-,and 5-year after surgical operation were calculated. The COX univariate analysis was used to examine the relations between recurrence or canceration in vocal cord leukoplakia and each of clinic factors including sex,age,smoking,alcohol consumption,lesion size,and histopathological classification. Then relations of these selected factors with recurrence or canceration in vocal cord leukoplakia were evaluated by using multiple COX regression analysis.Results There were 107 cases of recurrence and 43 cases of larynx cancer in the 416 patients with vocal cord leukoplakia after surgical operation. The 1-,3- and 5-year ratios of recurrence were 9. 4%,20. 8%,and 26. 0%. And the 1-,3- and 5-year ratios of canceration were 1. 9%,6. 7%,and 10. 2%. The age,lesion size,and histopathological classification were chosen as risk factors incorporated into both recurrence and canceration multiple COX regression models. The multiple COX regression showed that lesion size and histopathological classification were the risks of recurrence in vocal cord leukoplakia,and histopathological classification was the risk of canceration in vocal cord leukoplakia. Conclusions The lesion size and histopathological classification are predictive risk factors for recurrence in vocal cord leukoplakia after mucosal exfoliation,and the histopathological classification is the predictive risk factor for canceration. Moderate dysplasia and severe dysplasia are high risk factors of recurrence and canceration.