laryngeal neoplasms

喉肿瘤
  • 文章类型: Journal Article
    在过去的20年里,喉癌治疗的模式已经转向在不牺牲肿瘤结局的前提下保留喉功能.经口激光显微手术削弱了开放喉手术的作用。对于早期喉癌,常见的主要方式是内窥镜喉部手术和窄场放射。对于晚期喉癌,可以选择全喉切除术,然后进行放疗或放化疗。在经验丰富的双手和细致的患者选择之后,喉上骨切除术可以作为全喉切除术的可行替代方案,以保留喉功能。对于气道受损和/或喉功能障碍的患者,全喉切除术仍然是推荐的治疗方法。
    Over the last 2 decades, the paradigm of laryngeal cancer management has pivoted toward preserving laryngeal function without sacrificing oncologic outcomes. Transoral laser microsurgery has diminished the role of open laryngeal surgery. For early-stage laryngeal cancer, the common primary modalities are endoscopic laryngeal surgery and narrow field radiation. Total laryngectomy followed by either radiation or chemoradiation is option for advanced laryngeal cancer. In experienced hands and following meticulous patient selection, supracricoid laryngectomy may serve as a viable alternative to total laryngectomy to preserve laryngeal function. Total laryngectomy is still the recommended treatment in those with airway compromise and/or laryngeal dysfunction.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    目的:探讨经口激光显微手术(TLM)后复发或不复发的早期声门型喉癌(EGC)的临床特征与CT表现之间的差异,并建立术前列线图以预测术后复发。
    方法:回顾性分析168例伴或不伴复发的EGC患者的临床和CT表现。采用多因素logistic回归分析确定复发的独立预测因子。建立列线图以预测术前复发。要评估列线图的性能,使用C指数和校准图。
    结果:有复发和无复发的EGCs在T分期中存在显著差异,深度,动脉期(NCTAP)和静脉期(NCTVP)的归一化CT值(均P<0.05)。T-stage,深度,NCTVP和NCTVP是EGCs复发的独立预测因子(均P<0.05)。C指数(0.765,95%置信区间:0.703-0.827)和校准图表明,列线图具有良好的预测准确性。基于T分期和CT变量的列线图提供了数字预测的复发率,并且优于仅基于T分期的列线图(C指数为0.765vs.0.608)。
    结论:使用临床和CT变量,我们开发了一个新的列线图来预测TLM之前EGC的复发,这可能是指导个性化治疗的潜在非侵入性工具。
    OBJECTIVE: To explore the differences between clinical features and computed tomography (CT) findings of early-stage glottic cancer (EGC) with or without recurrence after transoral laser microsurgery (TLM) and to establish a preoperative nomogram to predict postoperative recurrence.
    METHODS: The clinical and CT features of 168 consecutive patients with EGC with or without recurrence were analyzed retrospectively. Multivariate logistic regression analysis was used to determine the independent predictors of recurrence. A nomogram was constructed to preoperatively predict recurrence. To assess the nomogram\'s performance, the C-index and calibration plot were used.
    RESULTS: EGCs with and without recurrence differed significantly in T-stage, depth, and normalized CT values in the arterial phase (NCTAP) and venous phase (NCTVP) (all P < 0.05). T-stage, depth, and NCTVP were independent predictors of recurrence in EGCs (all P < 0.05). The C-index (0.765, 95% confidence interval: 0.703-0.827) and calibration plot showed that the nomogram has good prediction accuracy. Nomograms based on T-stage and CT variables provided numerically predicted recurrence rates and were better than those based on only T-stage (C-index of 0.765 vs. 0.608).
    CONCLUSIONS: Using clinical and CT variables, we developed a novel nomogram to predict the recurrence of EGC before TLM, which may be a potential noninvasive tool for guiding personalized treatment.
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    文章类型: Case Reports
    喉神经节旁瘤是神经c衍生的罕见神经内分泌肿瘤,起源于上或下喉神经节旁。它最常见于声门上型,平均年龄为44岁,女性多见三倍。这是一例39岁的女性,接受了内镜下切除肿瘤的组织病理学检查,证明是低分化的鳞状细胞癌,并接受了一个化疗周期,可能导致最初的肿块完全消退,并在随后的随访中得到证实。进一步免疫组织化学检查诊断为喉副神经节瘤。有了这个考虑,化疗在治疗已证实的喉副神经节瘤中的作用如何?
    Laryngeal paragangliomas are neural crest derived rare neuroendocrine tumors which originates from either superior or inferior laryngeal paraganglia. It arises most commonly in supraglottis with mean age of 44 years and it is three times more common in females. This is a case of 39 years female who underwent endoscopic debulking and excision of tumor for histopathological examination which proved to be poorly differentiated squamous cell carcinoma and received a cycle of chemotherapy that probably resulted in complete resolution of initial mass which was confirmed in subsequent follow up. Futher immunohistochemistry examination diagnosed the case as Laryngeal paraganglioma. With this consideration, how effective is the role of chemotherapy in the management of proven case of Laryngeal paragangliomas?
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  • 文章类型: Systematic Review
    背景:窄带成像是一种先进的内窥镜技术,用于检测喉组织表面的变化,采用比较方法与白光内窥镜检查,以促进组织病理学检查。目的:本研究旨在通过与组织病理学检查的比较分析,评估NBI(窄带成像)在识别喉部恶性病变中的实用性和优势。方法:我们进行了系统的文献综述,利用PubMed等数据库,CNKI数据库,和Embase为我们的研究。结果:我们通过回顾文章的标题和摘要来分析文章,根据确定的标准选择我们认为相关的;在最后阶段,我们根据具体的资格标准审查了相关研究.结论:窄带成像是一种先进的内镜技术,可证明其作为诊断喉恶性病变并将其与癌前病变进行比较的工具的有效性。欧洲喉科学会已经实施了用于喉部病变的标准化分类系统,以增强数据相关性和组织。
    Background: Narrow-band imaging is an advanced endoscopic technology used to detect changes on the laryngeal tissue surface, employing a comparative approach alongside white-light endoscopy to facilitate histopathological examination. Objective: This study aimed to assess the utility and advantages of NBI (narrow-band imaging) in identifying malignant laryngeal lesions through a comparative analysis with histopathological examination. Methods: We conducted a systematic literature review, utilizing databases such as PubMed, the CNKI database, and Embase for our research. Results: We analyzed the articles by reviewing their titles and abstracts, selecting those we considered relevant based on determined criteria; in the final phase, we examined the relevant studies according to the specific eligibility criteria. Conclusions: Narrow-band imaging is an advanced endoscopic technology that demonstrates its efficacy as a tool for diagnosing malignant laryngeal lesions and comparing them to premalignant lesions. The European Society of Laryngology has implemented a standardized classification system for laryngeal lesions to enhance data correlation and organization.
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  • 文章类型: Case Reports
    以前没有研究发表声门下多形性腺瘤的磁共振成像(MRI)发现。这里,我们描述了一个62岁患有声门下多形性腺瘤的病例。内窥镜检查发现声门下后壁出现光滑表面的肿瘤。MRI在T1加权图像上显示病变为等强度区域,均匀增强。该病变在T2加权图像上显示出异质高强度区域。扩散加权成像(DWI)显示同一区域的强度稍高,具有正常或仅稍高的表观扩散系数(ADC)。经口切除声门下肿瘤进行了喉显微手术,导致多形性腺瘤的术后诊断。
    No previous study has published magnetic resonance imaging (MRI) findings for a subglottic pleomorphic adenoma. Here, we describe the case of a 62-year-old man with a subglottic pleomorphic adenoma. Endoscopic findings revealed a smooth-surfaced tumor arising from the subglottic posterior wall. MRI revealed the lesion as an isointense region on T1-weighted images, which was homogeneously enhanced. This lesion showed a heterogeneously hyperintense region on T2-weighted images. Diffusion-weighted imaging (DWI) showed slightly high intensity in the same area, with a normal or only slightly high apparent diffusion coefficient (ADC). Laryngomicrosurgery was performed for transoral excision of the subglottic tumor, resulting in a postsurgical diagnosis of pleomorphic adenoma.
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  • 文章类型: Journal Article
    炎症在癌症的发展过程中起着重要作用。近年来,评估炎症生物标志物预测生存能力的研究数量有所增加。本研究旨在全面评估炎性生物标志物在喉癌患者接受确定性放疗中的预测作用。回顾性检查了在我们中心接受喉癌明确放疗的101例患者。患者放疗前取血样获取C反应蛋白(CRP)等生物标志物,中性粒细胞-淋巴细胞比率(NLR),血小板-淋巴细胞比率(PLR),单核细胞-淋巴细胞比率(MLR),全身免疫炎症指数(SII),泛免疫炎症值(PIV),血嗜酸性粒细胞炎症指数(HEI),白蛋白,和乳酸脱氢酶(LDH)。该研究检查了无进展生存期(PFS)参数的预测价值,无局部复发生存率(LRFS),使用单变量和多变量Cox回归分析和总生存期(OS)。在单变量分析中,预测PFS的生物标志物是SII,PIV,CRP,和东部肿瘤协作组绩效状态(ECOGPS)。根据多变量分析,只有CRP被发现是PFS的显著预测因子.在单变量分析中,发现以下生物标志物可以预测OS:NLR,PLR,MLR,SII,PIV,CRP,HEI,舞台,和ECOGPS。在多变量分析中,发现NLR和ECOGPS是OS的预测因子。在MLR中发现了显著差异,PIV,和基于淋巴转移的CRP值。当前的研究是第一个全面检查喉癌与几种炎症生物标志物之间关系的研究。这些生物标志物中的许多已被证明可以预测正在接受明确放射治疗的喉癌患者的PFS和OS。已显示,除PFS和OS外,PIV和CRP还可以预测淋巴转移的存在。
    Inflammation plays an important role in the process of cancer development. The number of studies evaluating the ability of inflammatory biomarkers to predict survival has increased in recent years. This study aimed to comprehensively evaluate the predictive role of inflammatory biomarkers in patients with larynx cancer undergoing definitive radiotherapy. A total of 101 patients who underwent definitive radiotherapy for larynx cancer at our center were retrospectively examined. Blood samples were taken from the patients before radiotherapy to obtain biomarkers such as C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), pan-immune inflammatory value (PIV), hemo-eosinophil inflammation index (HEI), albumin, and Lactate dehydrogenase (LDH). The study examined the predictive value of parameters for progression-free survival (PFS), local recurrence-free survival (LRFS), and overall survival (OS) using both univariate and multivariate Cox regression analysis. In the univariate analysis, the biomarkers that predicted PFS were SII, PIV, CRP, and Eastern Cooperative Oncology Group Performance Status (ECOG PS). According to the multivariate analysis, only CRP was found to be a significant predictor of PFS. In the univariate analysis, the following biomarkers were found to predict OS: NLR, PLR, MLR, SII, PIV, CRP, HEI, stage, and ECOG PS. In the multivariate analysis, NLR and ECOG PS were found to be predictors of OS. A significant difference was found in MLR, PIV, and CRP values based on the presence of lymphatic metastasis. The current study is the first to comprehensively examine the relationship between larynx cancer and several inflammatory biomarkers. Many of these biomarkers have been shown to predict both PFS and OS in patients with larynx cancer undergoing definitive radiotherapy. It has been shown that PIV and CRP may predict the presence of lymphatic metastases in addition to PFS and OS.
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  • 文章类型: English Abstract
    The scope of this article was to analyze the five-year survival rate among patients with laryngeal cancer treated in the Unified Health System in Brazil and its regions between January 2002 and June 2010. There is still scarce information in Brazil regarding the scale and survival rate of laryngeal cancer patients, which makes it difficult to adopt specific strategies for the control of the condition in the country. A retrospective cohort study based on the National Oncology Database was conducted, and the survival probability rate for laryngeal cancer according to age, sex and Brazilian regions/states was estimated using the Kaplan-Meier method. The log-rank test was used to assess the differences observed, considering a 5% significance level. Survival in Brazil was estimated at 50.8% (95%CI: 49.9%-51.8%), being lower among male patients (49.1%; 95%CI: 48.10%-50.16%); between 50 and 60 years of age (48.4%; 95%CI: 46.7%-50.0%); for residents of the Northern region (45.5%; 95%CI: 39.5%-51.3%). The regional variation in the survival rate for laryngeal cancer in Brazil reveals disparities between Brazilian regions/states that may be linked to inequality of access to diagnosis and/or treatment.
    O objetivo do artigo foi analisar a sobrevida de cinco anos em pacientes com câncer de laringe tratados no Sistema Único de Saúde no Brasil e regiões entre janeiro de 2002 e junho de 2010. São escassas as informações relativas à magnitude e sobrevida do câncer de laringe no país, o que dificulta a adoção de estratégias específicas para seu controle. Foi realizado um estudo de coorte retrospectiva a partir da Base Nacional em Oncologia. Estimou-se a probabilidade de sobrevida para o câncer de laringe segundo faixa etária, sexo e regiões/estados brasileiros por meio do método de Kaplan-Meier. O teste de log-rank foi aplicado para avaliar as diferenças na sobrevida, considerando-se o nível de significância de 5%. A sobrevida no Brasil foi estimada em 50,8% (IC95%: 49,9-51,8), sendo menor em pacientes do sexo masculino (49,1%; IC95%: 48,10-50,16); com idade entre 50 e 60 anos (48,4%; IC95%: 46,7-50,0); e para moradores da região Norte (45,5%; IC95%: 39,5-51,3). A variação na sobrevida para o câncer de laringe em relação aos estados e às regiões do país aponta disparidades que podem estar relacionadas à desigualdade de acesso ao diagnóstico e/ou tratamento.
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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    患者,女,16岁,因“进行性声嘶加重、呼吸道乳头状瘤反复复发15年”入院。患者自1岁时出现声嘶外院就诊,喉镜示:喉肿物(复发性喉乳头状瘤?),遂行支撑喉镜下喉肿物切除术(具体术式不详),术后病理:喉乳头状瘤。术后4个月余复发,再次手术治疗;后每间隔1~4个月复发并给予手术治疗,直至10岁;10~12岁手术间隔为1年;12~14岁时手术间隔约半年;14~15岁时手术间隔约3个月;共计接受手术40余次。15岁后乳头状瘤病变范围逐渐扩大,于2022年5月我院就诊。查体:喉部多发乳头状瘤,声带黏连,喉狭窄,肺内乳头状瘤播散。入院后,为患者制订阶梯治疗方案:先行全身贝伐珠单抗治疗(4次),喉部及肺内乳头状瘤病灶均明显缩小;后行经支撑喉镜CO2激光喉乳头状瘤切除术+光动力治疗(3次),至今术后19个月喉部乳头状瘤未复发。目前进一步定期随访中。.
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