目的:声门型喉癌TLM后边缘状态的值值得商榷,由于标本定位和边缘分析的困难。为了减少这些困难,我们最近引入了TLM标本定向固定的标准化方案.这被证明是可行的,并导致高边缘可评估率和假阳性深度边缘率降低,与历史TLM队列相比。对于根据此协议处理标本的患者,我们前瞻性分析了肿瘤结果,与历史TLM队列相比,确定预后因素并评估方案引入对结局的影响.
方法:纳入了接受TLM治疗的96例声门恶性肿瘤患者。根据新方案处理切除标本。描述性统计和生存分析用于确定肿瘤结果。为了评估方案引入对结果的影响,进行了匹配的病例对照分析,使用历史TLM队列作为对照。采用Cox比例风险模型分析患者的预后效果及治疗特点,包括病理学方案介绍,关于总生存期(OS),疾病特异性生存率(DSS),无病生存率(DFS)和无局部复发生存率(LRFS)。
结果:两年的结果是有利的:88.5%的OS,97.0%DSS,和87.6%的LRFS。在多变量分析中,多个阳性表面边缘的存在是OS的阴性预测因子(HR4.102),而增加的cT分类证明是DFS(HR2.828)和LRFS(HR2.676)的阴性预测因子.匹配的病例对照分析未显示队列之间肿瘤结局的显着差异。深度边缘状态对队列之间的DFS(相互作用的p值=0.0205)和LRFS(相互作用的p值=0.0176)有很强的差异效应,表明深度边缘状态对当前队列中两种结局的预后影响,但不是在历史队列中。
结论:与历史TLM队列相比,引入一种新的TLM标本定向固定标准化技术并不影响肿瘤结局,但对DFS和LRFS的深度边缘状态具有显著的预后影响,促进关于规划第二眼程序的决策过程,给予辅助放疗或确定随访强度。
OBJECTIVE: The value of margin status after TLM for glottic cancer is debatable, due to difficulties in specimen orientation and margin analysis. To reduce these difficulties, we recently introduced a standardized protocol of oriented fixation of TLM specimens. This proved feasible and resulted in high margin evaluability rates and a decreased rate of false positive deep margins, when compared to a historical TLM cohort. For the patients whose specimens were processed according to this protocol, we prospectively analyzed oncological outcomes, identified prognostic factors and assessed the influence of the protocol introduction on outcomes compared with a historical TLM cohort.
METHODS: Ninety-six patients with glottic malignancies treated with TLM were included. Resection specimens were processed according to the new protocol. Descriptive statistics and survival analyses were used to determine oncological outcomes. To assess the effect of the protocol introduction on outcomes, a matched-case-control analysis was performed, using a historical TLM-cohort as controls. The Cox proportional hazards model was used to analyze prognostic effects of patient and treatment characteristics, including the pathology protocol introduction, on overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS) and local recurrence-free survival (LRFS).
RESULTS: Two-year outcomes were favorable: 88.5% OS, 97.0% DSS, and 87.6% LRFS. At multivariable analysis, the presence of multiple positive superficial margins was a negative prognosticator for OS (HR 4.102) and increasing cT classification proved a negative prognosticator for DFS (HR 2.828) and LRFS (HR 2.676). Matched case-control analysis did not reveal a significant difference in oncological outcomes between cohorts. Deep margin status had a strong differential effect for DFS (p-value for interaction = 0.0205) and for LRFS (p-value for interaction = 0.0176) between cohorts, indicating a prognostic effect of deep margin status on both outcomes in the current cohort, but not in the historical cohort.
CONCLUSIONS: The introduction of a new standardized technique of oriented fixation of TLM specimens did not affect oncological outcomes when compared to a historical TLM cohort, but assigned a significant prognostic effect to deep margin status for DFS and LRFS, facilitating the decision making process with regards to planning of second-look procedures, administration of adjuvant radiotherapy or determination of follow-up intensity.