PDF(Pubmed)
Abstract：
OBJECTIVE: The involvement of the anterior commissure (AC) is regarded to be a risk factor for poor results after transoral laser microsurgery (TLM) for early glottic cancer. The objective of this study was to determine how AC-related clinical and radiological factors affected oncological outcomes in a cohort of patients with T1 stage early glottic carcinoma involving the anterior commissure who were treated with TLM with negative surgical margins.
METHODS: Retrospective analysis was performed on clinical, radiological, and follow-up data of patients consecutively treated with TLM at a tertiary academic center between November 2011 and August 2021 for T1 glottic squamous cell carcinoma involving the anterior commissure. Recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) rates (Kaplan-Meier) were the primary outcome metrics.
RESULTS: In our series, 5-year OS probability was 75.1%, RFS was 64.8%, LCL was 73.8%, and LP was 83.4%. OS and RFS were higher in patients with early stages of AC pattern than in patients with advanced stage (p = 0.004, p = 0.034, respectively). Vertical extension ratio was found to be associated with OS and RFS (p = 0.023, p = 0.001, respectively), and thyroid cartilage interlaminar angle with LCL by multiple Cox regression analysis (p = 0.041).
CONCLUSIONS: TLM remains a valuable treatment option for AC involvement. AC3 type involvement and elevated vertical extension ratio were associated with negative prognosis. There have been signs that thyroid cartilage with a narrow angle increases recurrence. Alternative modalities should be kept in mind in the treatment decision of these cases.
METHODS: Retrospective analysis was performed on clinical, radiological, and follow-up data of patients consecutively treated with TLM at a tertiary academic center between November 2011 and August 2021 for T1 glottic squamous cell carcinoma involving the anterior commissure. Recurrence-free survival (RFS), local control with laser alone (LCL), laryngeal preservation (LP), and overall survival (OS) rates (Kaplan-Meier) were the primary outcome metrics.
RESULTS: In our series, 5-year OS probability was 75.1%, RFS was 64.8%, LCL was 73.8%, and LP was 83.4%. OS and RFS were higher in patients with early stages of AC pattern than in patients with advanced stage (p = 0.004, p = 0.034, respectively). Vertical extension ratio was found to be associated with OS and RFS (p = 0.023, p = 0.001, respectively), and thyroid cartilage interlaminar angle with LCL by multiple Cox regression analysis (p = 0.041).
CONCLUSIONS: TLM remains a valuable treatment option for AC involvement. AC3 type involvement and elevated vertical extension ratio were associated with negative prognosis. There have been signs that thyroid cartilage with a narrow angle increases recurrence. Alternative modalities should be kept in mind in the treatment decision of these cases.
摘要：
目的：前连合（AC）的受累被认为是经口激光显微手术（TLM）治疗早期声门癌效果不佳的危险因素。这项研究的目的是确定与AC相关的临床和放射学因素如何影响涉及前连合的T1期早期声门癌患者队列的肿瘤学结果。
方法：对临床、放射学,以及2011年11月至2021年8月在三级学术中心连续接受TLM治疗的T1声门鳞状细胞癌累及前连合的患者的随访数据.无复发生存率（RFS），单独使用激光（LCL）的局部控制，喉保存（LP），和总生存(OS)率(Kaplan-Meier)是主要结局指标.
结果：在我们的系列中，5年OS概率为75.1%，RFS为64.8%，LCL为73.8%，LP为83.4%。早期AC型患者的OS和RFS高于晚期患者（分别为p=0.004，p=0.034）。发现垂直扩展比与OS和RFS相关（分别为p=0.023，p=0.001），和甲状软骨层间角度与LCL经多重Cox回归分析(p=0.041)。
结论：TLM仍然是AC受累的有价值的治疗选择。AC3型受累和垂直延伸比升高与阴性预后相关。有迹象表明，狭窄角度的甲状软骨会增加复发。在这些病例的治疗决定中应牢记其他方式。
方法：对临床、放射学,以及2011年11月至2021年8月在三级学术中心连续接受TLM治疗的T1声门鳞状细胞癌累及前连合的患者的随访数据.无复发生存率（RFS），单独使用激光（LCL）的局部控制，喉保存（LP），和总生存(OS)率(Kaplan-Meier)是主要结局指标.
结果：在我们的系列中，5年OS概率为75.1%，RFS为64.8%，LCL为73.8%，LP为83.4%。早期AC型患者的OS和RFS高于晚期患者（分别为p=0.004，p=0.034）。发现垂直扩展比与OS和RFS相关（分别为p=0.023，p=0.001），和甲状软骨层间角度与LCL经多重Cox回归分析(p=0.041)。
结论：TLM仍然是AC受累的有价值的治疗选择。AC3型受累和垂直延伸比升高与阴性预后相关。有迹象表明，狭窄角度的甲状软骨会增加复发。在这些病例的治疗决定中应牢记其他方式。
