Abstract：
OBJECTIVE: Laser cordectomy is a widely accepted treatment modality for selected cases of early glottic cancers, but its role as a salvage treatment remains unclear. We aimed to investigate the oncological outcomes and failure patterns of salvage cordectomy.
METHODS: This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival.
RESULTS: A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9).
CONCLUSIONS: Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.
METHODS: This was a retrospective cohort study of patients who underwent cordectomy for early glottic cancer between 2013 and 2022 at a tertiary referral center. The main outcome measures were overall survival, larynx-preservation rate, tracheostomy dependency rate, and disease-free survival.
RESULTS: A total of 142 patients (mean age: 63 years, interquartile range [IQR]: 45-72, 123[86.9 %] males) were analyzed. There were 38 (26.8 %) recurrences after a mean of 22 months (IQR: 17-26). Among them, 25 (17.6 %) underwent salvage cordectomy, while 13 (9.1 %) received other salvage treatments (11[7.7 %] (chemo)radiotherapy and 2[1.4 %] total laryngectomy). In comparison to the other salvage treatments, salvage cordectomy demonstrated lower tracheostomy rates (0 vs. 31 %, p = 0.05), comparable 5-year disease-free survival (62 % vs. 54 %, p = 0.4), higher 5-year larynx preservation rate (92 % vs. 54 %, p = 0.02), and improved 5-year overall survival rate (84 % vs. 62 %, p = 0.01). Factors associated with salvage cordectomy failure were age >60 years (odds ratio [OR]: 1.3, 95 % confidence interval [CI]: 1.15-1.53), smoking continuation (OR: 3.73, 95 % CI: 3.5-4.4), heavy smoking (OR: 1.24, 95 % CI:1.07-2.15), and pT1b + (OR: 2.26, 95 % CI: 2.1-2.9).
CONCLUSIONS: Salvage cordectomy offers favorable larynx preservation rates and oncological outcomes for recurrent disease amenable to conservative surgery. Smoking, advanced age, and advanced tumor stages are associated with salvage cordectomy failure.
摘要：
目的：对于选定的早期声门型喉癌，激光治疗是一种被广泛接受的治疗方式。但其作为抢救治疗的作用尚不清楚。我们的目的是调查肿瘤的结果和失败模式的挽救性科切。
方法：这是一项回顾性队列研究，研究对象是2013年至2022年在三级转诊中心因早期声门癌接受了声带切除术的患者。主要结果指标是总生存期，喉保存率,气管造口术依赖率，和无病生存。
结果：共142例患者（平均年龄：63岁，四分位间距[IQR]：45-72，123[86.9%]男性）进行了分析。平均22个月后有38例（26.8%）复发（IQR：17-26）。其中,25例（17.6%）接受了挽救性导管切除术，13例（9.1％）接受了其他挽救性治疗（11例[7.7％]（化学）放疗和2例[1.4％]全喉切除术）。与其他抢救治疗相比，挽救性子宫切除术显示出更低的气管造口术率(0vs.31%,p=0.05)，可比较的5年无病生存率(62%与54%,p=0.4),较高的5年喉部保存率(92%vs.54%,p=0.02),并提高5年总生存率(84%vs.62%,p=0.01)。与挽救性导管切除术失败相关的因素是年龄>60岁（比值比[OR]：1.3，95％置信区间[CI]：1.15-1.53），继续吸烟（OR：3.73，95%CI：3.5-4.4），大量吸烟（OR：1.24，95%CI：1.07-2.15），和pT1b+（OR：2.26，95%CI：2.1-2.9）。
结论：挽救性导管切除术对保守性手术的复发性疾病具有良好的喉保存率和肿瘤结局。吸烟,高龄,和晚期肿瘤分期与挽救性导管切除术失败有关。
方法：这是一项回顾性队列研究，研究对象是2013年至2022年在三级转诊中心因早期声门癌接受了声带切除术的患者。主要结果指标是总生存期，喉保存率,气管造口术依赖率，和无病生存。
结果：共142例患者（平均年龄：63岁，四分位间距[IQR]：45-72，123[86.9%]男性）进行了分析。平均22个月后有38例（26.8%）复发（IQR：17-26）。其中,25例（17.6%）接受了挽救性导管切除术，13例（9.1％）接受了其他挽救性治疗（11例[7.7％]（化学）放疗和2例[1.4％]全喉切除术）。与其他抢救治疗相比，挽救性子宫切除术显示出更低的气管造口术率(0vs.31%,p=0.05)，可比较的5年无病生存率(62%与54%,p=0.4),较高的5年喉部保存率(92%vs.54%,p=0.02),并提高5年总生存率(84%vs.62%,p=0.01)。与挽救性导管切除术失败相关的因素是年龄>60岁（比值比[OR]：1.3，95％置信区间[CI]：1.15-1.53），继续吸烟（OR：3.73，95%CI：3.5-4.4），大量吸烟（OR：1.24，95%CI：1.07-2.15），和pT1b+（OR：2.26，95%CI：2.1-2.9）。
结论：挽救性导管切除术对保守性手术的复发性疾病具有良好的喉保存率和肿瘤结局。吸烟,高龄,和晚期肿瘤分期与挽救性导管切除术失败有关。
