Abstract：
OBJECTIVE: To assess the value of carbon dioxide transoral laser microsurgery (CO2 TOLMS) for early-stage glottic cancer with special regard to involvement of the anterior commissure (AC).
METHODS: Single-center retrospective cohort study.
METHODS: Grade-A tertiary hospital.
METHODS: A retrospective analysis of patients with early-stage (Tis-T2) glottic cancer who underwent CO2 TOLMS. All patients had at least 2 years of follow-up. The univariate and multivariate survival analyses were used to identify the risk factors for recurrence and the Kaplan-Meier method was used to analyze OS and DSS rates.
RESULTS: A total of 102 patients were included in the study. Eleven patients (10.78%) had recurrence. The univariate analysis showed that the recurrence was associated with the AC classification, T staging, tumor size, and tobacco use (P < .05). However, on multivariate analysis, the AC classification was the only independent risk factor for recurrence (P < .001, HR = 3.179). AC classification were distributed as follows: 59 (57.84%) AC0, 29 (28.43%) AC1, 8 (7.84%) AC2, and 6 (5.88%) AC3, 2-year/5-year OS and DSS rates were progressively reduced in the AC0, AC1, AC2, and AC3 groups (P < .001). At the same T staging, the OS rates incrementally decreased as the level of involvement of the AC became higher (P = .004).
CONCLUSIONS: CO2 TOLMS is an effective treatment for early-stage glottic cancer. AC involvement is an independent risk factors for recurrence and poor prognosis. The AC classification system may be better at grading the prognosis of patients with early-stage glottic cancer and has prognostic value independent of T staging.
METHODS: Single-center retrospective cohort study.
METHODS: Grade-A tertiary hospital.
METHODS: A retrospective analysis of patients with early-stage (Tis-T2) glottic cancer who underwent CO2 TOLMS. All patients had at least 2 years of follow-up. The univariate and multivariate survival analyses were used to identify the risk factors for recurrence and the Kaplan-Meier method was used to analyze OS and DSS rates.
RESULTS: A total of 102 patients were included in the study. Eleven patients (10.78%) had recurrence. The univariate analysis showed that the recurrence was associated with the AC classification, T staging, tumor size, and tobacco use (P < .05). However, on multivariate analysis, the AC classification was the only independent risk factor for recurrence (P < .001, HR = 3.179). AC classification were distributed as follows: 59 (57.84%) AC0, 29 (28.43%) AC1, 8 (7.84%) AC2, and 6 (5.88%) AC3, 2-year/5-year OS and DSS rates were progressively reduced in the AC0, AC1, AC2, and AC3 groups (P < .001). At the same T staging, the OS rates incrementally decreased as the level of involvement of the AC became higher (P = .004).
CONCLUSIONS: CO2 TOLMS is an effective treatment for early-stage glottic cancer. AC involvement is an independent risk factors for recurrence and poor prognosis. The AC classification system may be better at grading the prognosis of patients with early-stage glottic cancer and has prognostic value independent of T staging.
摘要：
目的：评估二氧化碳经口激光显微手术（CO2-TOLMS）治疗早期声门型喉癌的价值，特别是前连合（AC）受累。
方法：单中心回顾性队列研究。
方法：三级甲等医院。
方法：对接受CO2TOLMS的早期（Tis-T2）声门型喉癌患者进行回顾性分析。所有患者都有至少2年的随访。使用单因素和多因素生存分析来确定复发的危险因素，并使用Kaplan-Meier方法分析OS和DSS率。
结果：本研究共纳入102例患者。11例（10.78%）患者复发。单因素分析显示复发与AC分类有关,T分期,肿瘤大小,和烟草使用（P<0.05）。然而,在多变量分析中，AC分级是复发的唯一独立危险因素(P<.001,HR=3.179).AC分类分布如下：59（57.84％）AC0，29（28.43％）AC1，8（7.84％）AC2和6（5.88％）AC3，2年/5年OS和DSS率在AC0，AC1，AC2和AC3组中逐渐降低（P<0.001）。在同一个T分期，随着AC的参与程度升高，OS率逐渐降低（P=.004）。
结论：CO2TOLMS是治疗早期声门型喉癌的有效方法。AC受累是复发和预后不良的独立危险因素。AC分类系统可能更好地对早期声门型喉癌患者的预后进行分级，并且具有独立于T分期的预后价值。
方法：单中心回顾性队列研究。
方法：三级甲等医院。
方法：对接受CO2TOLMS的早期（Tis-T2）声门型喉癌患者进行回顾性分析。所有患者都有至少2年的随访。使用单因素和多因素生存分析来确定复发的危险因素，并使用Kaplan-Meier方法分析OS和DSS率。
结果：本研究共纳入102例患者。11例（10.78%）患者复发。单因素分析显示复发与AC分类有关,T分期,肿瘤大小,和烟草使用（P<0.05）。然而,在多变量分析中，AC分级是复发的唯一独立危险因素(P<.001,HR=3.179).AC分类分布如下：59（57.84％）AC0，29（28.43％）AC1，8（7.84％）AC2和6（5.88％）AC3，2年/5年OS和DSS率在AC0，AC1，AC2和AC3组中逐渐降低（P<0.001）。在同一个T分期，随着AC的参与程度升高，OS率逐渐降低（P=.004）。
结论：CO2TOLMS是治疗早期声门型喉癌的有效方法。AC受累是复发和预后不良的独立危险因素。AC分类系统可能更好地对早期声门型喉癌患者的预后进行分级，并且具有独立于T分期的预后价值。
