T1期声门型喉鳞癌垂直部分喉切除术后局部复发与手术切缘的相关性

Correlation between local recurrence and after vertical partial laryngectomy and surgical margin for stage T glottic squamous cell carcinoma

目的:探讨T1期声门型喉鳞癌垂直部分喉切除术后局部复发与手术切缘的相关性。方法:回顾性分析我院于2013年2月-2015年2月收治的120例接受垂直部分喉切除术的喉癌患者的临床资料,所有患者出院后进行至少5年的随访,根据是否存在局部复发分为局部复发组(n=8)和无复发组(n=112)。比较两组患者手术切缘边距及病理结果、肿瘤直径和浸润深度组成的肿瘤学检测指标。结果:复发组后外测切缘边距(PLSM)、后外测切缘边距与上下直径比值(PLSM/ULD)、后外测切缘边距与内外直径比值PLSM/IED、后外测切缘边距与平均直径比值(PLSM/AD)及最短切缘边距明显低于非复发组,差异具有统计学意义(P<0.05)。且术后的病理结果显示,复发组有6例患者肿瘤切缘边距<5 mm,2例患者肿瘤切缘的边距≥5 mm;而无复发组10例患者肿瘤切缘边距<5 mm,102例患者肿瘤切缘的边距≥5 mm。复发组肿瘤切缘边距<5 mm的发生率明显高于无复发组,差异具有统计学意义(P<0.001)。术后随访期间,两组患者的3年及5年总生存率相比较差异无显著统计学意义(P>0.05)。结论:PLSM较低对T1声门鳞状细胞癌垂直部分喉切除术后局部复发有重要影响,且垂直部分喉切除术过程中手术切缘边距不应超过5 mm。

Objective:To investigate the correlation between local recurrence and surgical margins after vertical partial laryngectomy for T1 glottic squamous cell carcinoma.Methods:The clinical data of 120 patients with laryngeal cancer who underwent a modified vertical partial laryngectomy admitted to our hospital from February 2013 to February 2015 were retrospectively analyzed.All patients were followed up for at least 5 years after discharge,depending on the existence of local recurrence was divided into local recurrence group(n=8)and non-recurrence group(n=112).Their surgical margins,pathological results,tumor diameters and invasion depths were recorded and compared between the two groups.Results:The margin distance(PLSM),the ratio of edge distance to upper and lower diameter(PLSM/ULD),the ratio of edge distance to inner and outer diameter(PLSM/IED),the ratio of edge distance to average diameter(PLSM/AD)and the shortest edge distance were significantly lower than those of non-recurrence group,the difference was statistically significant(P<0.05).And the pathological results showed that in recurrent group there were 6 patients with tumor margin<5 mm,2 patients with tumor margin≥5 mm;in non-recurrence group there were 10 patients with tumor margin<5 mm,102 patients with tumor margin≥5 mm,difference was statistically significant(P<0.001).During postoperative follow-up,There was no significant difference in the total overall survival of 3 and 5 years between the two groups(P>0.05).Conclusion:The lower PLSM has an important effect on the local recurrence after vertical partial laryngectomy of T1 glottic squamous cell carcinoma,and the margin of the surgical margin during vertical partial laryngectomy should not exceed 5 mm.