低温等离子手术治疗早期喉鳞状细胞癌整体预后及复发的相关因素研究

Prognostic and relapsing factors of early laryngeal cancertreated by low temperature plasma surgery

目的探讨低温等离子手术治疗早期喉鳞状细胞癌(简称喉癌)的整体预后情况,并评估相关风险因素对患者无病生存期(DFS)的影响,从而分析影响手术疗效的因素,总结临床经验。方法回顾性分析2013年4月—2020年12月接受经口内镜下低温等离子手术治疗、有完整随访资料的患者369例早期喉癌患者的临床资料。随访时间为32~124个月,中位随访时间72个月。并统计分析获得患者各项肿瘤学结果,包括DFS、总生存期(OS)、局部控制率(LC)、保喉率(LP)。结果术后共计70例患者出现复发,40例死亡。所有患者总的1、2、5年DFS分别为89%(95%CI:86%~92%)、85%(95%CI:82%~89%)、80%(95%CI:76%~84%),中位DFS未到达。1、2、5年OS分别为97%(95%CI:96%~99%)、92%(95%CI:89%~95%)、89%(95%CI:85%~92%),中位OS未到达。且累及前连合显著影响患者DFS,但对OS没有影响。而ACI患者1、2、5年DFS分别为87%(95%CI:82%~92%)、82%(95%CI:77%~88%)、76%(95%CI:70%~82%)。而未侵犯患者1、2、5年DFS分别为92%(95%CI:87%~96%),89%(95%CI:84%~93%),85%(95%CI:79%~91%)。结论等离子手术与CO_(2)激光手术或是单纯放疗的疗效较为接近。累及前连合与术后肿瘤切缘也是影响患者术后DFS的重要因素,并且术后复发患者的二次等离子手术并非禁忌。术前做好相应评估,在确认前连合区域外侧甲状软骨没有明显侵犯并且术前判断可以获得阴性切缘的情况下再考虑行等离子手术治疗,才能使患者获得最佳疗效。

Objective To investigate the overall prognosis of low-temperature plasma surgery for early laryngeal cancer,and to evaluate the influence of related risk factors on patients’disease free survival(DFS),so as to analyze the factors affecting the surgical effect and summarize clinical experience.Methods Clinical data of 369 patients with early laryngeal cancer who received endoscopic low-temperature plasma surgery in our hospital from April 2013 to December 2020 with complete follow-up data were retrospectively analyzed.The follow-up period ranged from 32 to 124 months,with a median follow-up of 72 months.Statistical analysis was performed to obtain various oncology results,including DFS,overal survival(OS),local control and laryngeal preservation rates.Results A total of 70 patients recurred and 40 died.Overall 1-,2-,and 5-year DFS for all patients were 89%(95%CI:86%-92%),85%(95%CI:82-89%),and 80%(95%CI:76%-84%),respectively,and the median DFS was not reached.The 1-,2-,and 5-year OS were 97%(95%CI:96%-99%),92%(95%CI:89%-95%),and 89%(95%CI:85%-92%),respectively,with the median OS not reached.Anterior commissure invasion significantly affected DFS,but had no effect on OS.The 1-,2-and 5-year DFS of ACI patients were 87%(95%CI:82-92%),82%(95%CI:77%-88%)and 76%(95%CI:70%-82%),respectively.In non-invasive patients,1-,2-and 5-year DFS were 92%(95%CI:87%-96%),89%(95%CI:84%-93%)and 85%(95%CI:79%-91%),respectively.Conclusion The efficacy of low-temperature plasma surgery is comparable to that of CO 2 laser surgery or radiotherapy alone.Anterior commissure invasion and postoperative incisal margin are also important factors affecting postoperative DFS,and the second plasma surgery is not contraindicated for patients with recurrence.Therefore,preoperative evaluation must be conducted accordingly,and only when it is confirmed that there is no obvious invasion of the lateral thyroid cartilage in the anterior commissure area and a negative incisal margin can be obtained before the treatment of plasma surgery is considered,can the patient obtain the optimal therapeutic effect.