T<sub>1</sub>期声门型喉鳞癌垂直部分喉切除术后局部复发与手术切缘的相关性-现代医学

T₁期声门型喉鳞癌垂直部分喉切除术后局部复发与手术切缘的相关性

单位：1. 扬州大学附属医院耳鼻咽喉科, 江苏扬州 225000;
2. 山东省青州市人民医院耳鼻咽喉科, 山东青州 262500;
3. 中国科学技术大学附属第一医院耳鼻咽喉科, 安徽合肥 230001

分类号：R739.65

出版年·卷·期（页码）：2021·49·第二期（163-167）

摘要：

目的：探讨T₁期声门型喉鳞癌垂直部分喉切除术后局部复发与手术切缘的相关性。方法：回顾性分析我院于2013年2月—2015年2月收治的120例接受垂直部分喉切除术的喉癌患者的临床资料，所有患者出院后进行至少5年的随访，根据是否存在局部复发分为局部复发组（n=8）和无复发组（n=112）。比较两组患者手术切缘边距及病理结果、肿瘤直径和浸润深度组成的肿瘤学检测指标。结果：复发组后外测切缘边距（PLSM）、后外测切缘边距与上下直径比值（PLSM/ULD）、后外测切缘边距与内外直径比值PLSM/IED、后外测切缘边距与平均直径比值（PLSM/AD）及最短切缘边距明显低于非复发组，差异具有统计学意义（P<0.05）。且术后的病理结果显示，复发组有6例患者肿瘤切缘边距<5 mm，2例患者肿瘤切缘的边距≥5 mm；而无复发组10例患者肿瘤切缘边距<5 mm，102例患者肿瘤切缘的边距≥5 mm。复发组肿瘤切缘边距<5 mm的发生率明显高于无复发组，差异具有统计学意义（P<0.001）。术后随访期间，两组患者的3年及5年总生存率相比较差异无显著统计学意义（P>0.05）。结论：PLSM较低对T₁声门鳞状细胞癌垂直部分喉切除术后局部复发有重要影响，且垂直部分喉切除术过程中手术切缘边距不应超过5 mm。

Objective:To investigate the correlation between local recurrence and surgical margins after vertical partial laryngectomy for T₁ glottic squamous cell carcinoma.Methods: The clinical data of 120 patients with laryngeal cancer who underwent a modified vertical partial laryngectomy admitted to our hospital from February 2013 to February 2015 were retrospectively analyzed. All patients were followed up for at least 5 years after discharge, depending on the existence of local recurrence was divided into local recurrence group (n=8) and non-recurrence group (n=112).Their surgical margins, pathological results, tumor diameters and invasion depths were recorded and compared between the two groups. Results:The margin distance (PLSM), the ratio of edge distance to upper and lower diameter (PLSM/ULD), the ratio of edge distance to inner and outer diameter(PLSM/IED), the ratio of edge distance to average diameter (PLSM/AD) and the shortest edge distance were significantly lower than those of non-recurrence group, the difference was statistically significant (P<0.05). And the pathological results showed that in recurrent group there were 6 patients with tumor margin <5 mm, 2 patients with tumor margin ≥ 5 mm; in non-recurrence group there were 10 patients with tumor margin <5 mm, 102 patients with tumor margin ≥ 5 mm, difference was statistically significant (P<0.001). During postoperative follow-up, There was no significant difference in the total overall survival of 3 and 5 years between the two groups (P>0.05).Conclusion:The lower PLSM has an important effect on the local recurrence after vertical partial laryngectomy of T₁ glottic squamous cell carcinoma, and the margin of the surgical margin during vertical partial laryngectomy should not exceed 5 mm.

参考文献：

[1] CHAI Y J,LEE J M,SEONG Y W.Application of continuous intraoperative neuromonitoring during VATS lobectomy for left lung cancer to prevent recurrent laryngeal nerve injury[J].Sci Rep,2020,10(1):4636.
[2] ONO T,TANAKA N,TANOUE S,et al.Organ preservation following radiation therapy and concurrent intra-arterial low dose cisplatin infusion for advanced T2 and T3 laryngeal cancer:Long-term clinical results from a pilot study[J].laryngoscope Investigative Otolaryngology,2020,5(1):55-65.
[3] PAPANIKOLAOU V,CHRYSOVERGIS A,MASTRONIKOLIS N,et al.Topoisomerase Ⅱa protein expression patterns in laryngeal squamous cell carcinoma[J].Anticancer Res,2020,40(2):807-811.
[4] PETRAROLHA S,DEDIVITIS R,MATOS L,et al.Lymph node density as a predictive factor for worse outcomes in laryngeal cancer[J].Eur Arch Otorhinolaryngol,2020,277(3):833-840.
[5] RAMOS-VEGA V,ROJAS B V,TORRES W D.Immunohistochemical analysis of cancer-associated fibroblasts and podoplanin in head and neck cancer[J].Med Oral Patol Oral Cir Bucal,2020,25(2):e268-e276.
[6] CHANG C P,LA V C,SERRAINO D,et al.Dietary glycaemic index,glycaemic load and head and neck cancer risk:a pooled analysis in an international consortium[J].Br J Cancer,2020,122(6):745-748.
[7] WANG J,QIN Y,ZHU G,et al.High serum CCL18 predicts a poor prognosis in patients with laryngeal squamous cell carcinoma[J].J Cancer,2019,10(27):6910-6914.
[8] 薛海翔,卞文超,李海峰,等.喉癌患者行支撑喉镜下二氧化碳激光切除术后的嗓音分析及声带新生观察[J].东南大学学报(医学版),2016,35(6):979-985.
[9] HANNA J,BRAUER P R,MORSE E, et al.Margins in laryngeal squamous cell carcinoma treated with transoral laser microsurgery:a national database study[J].Otolaryngol Head Neck Surg,2019,161(6):986-992.
[10] JUMAILY M,FARAJI F,OSAZUWA-PETERS N,et al.Prognostic significance of surgical margins after transoral laser microsurgery for early-stage glottic squamous cell carcinoma[J].Oral Oncology,2019,97(6):105-111.
[11] 曹峰,吕欣,董凯峰,等.C-Met抑制剂AMG-102增强喉鳞癌细胞放射敏感性的机制[J].中华肿瘤杂志,2019,41(12):909-917.
[12] KI S H,MA S H,SIM S H.Unplanned change from double free flap to a chimeric anterolateral thigh flap in recurrent laryngeal cancer[J].Arch Craniofac Surg,2019,20(6):416-420.
[13] OKAMOTO I,MATSUKI T,SATO H,et al.Post-operative complications due to salvage total laryngectomy for recurrent laryngeal cancer after radiotherapy-a multicentre retrospective study[J].Acta Otolaryngol,2020,140(2):170-174.
[14] ZOU Y,LI M,XING Y,et al.Bioimaging of glutathione with a two-photon fluorescent probe and its potential application for surgery guide in laryngeal cancer[J].ACS Sensors,2020,5(1):242-249.
[15] 刘红兵,刘月辉,罗英.喉癌的手术方式选择及远期疗效的分析[J].中国癌症杂志,2015,25(2):145-149.
[16] ADEEL M,FAISAL M,RASHID A,et al.Outcomes of definitive radiotherapy for early laryngeal cancer in terms of survival and patterns of failure[J].J Laryngol Otol,2019,133(12):1087-1091.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录