경구강 레이저 수술을 시행한 성문암 환자의 치료 결과 및 국소 재발의 예측 인자 (Oncologic Outcome and Predictor of Local Recurrence in Patients with Glottic Cancer Treated with Transoral Laser Microsurgery)

서지정보

· 발행기관 : 대한이비인후과학회
· 수록지 정보 : 대한이비인후-두경부외과학회지 / 63권 / 9호 / 415 ~ 421페이지
· 저자명 : 김선우, 김혜수, 남우주, 이상혁, 진성민

초록

Background and Objectives Transoral laser microsurgery (TLM) is minimally invasive andhas become the standard approach for early and intermediate stage laryngeal cancers. Manystudies show that the oncologic results of TLM are equivalent to those obtained by conventionalconservative surgery and radiotherapy (RT). The purpose of this study were to analyze the treatmentoutcome and predictors of local recurrence in glottic cancer patients who underwent TLM.
Subjects and Method Sixty-seven patients who received TLM for glottis cancer between2008 and 2019 were analyzed retrospectively. Patients were predominantly male (98.5%), witha median age of 64.3 years (range 45 to 87 years). There were 35 cases of T1 (52.2%), 15 casesof T2 (22.3%), and 17 cases of T3 (25.3%) in the primary tumor stage. There were no patientswith lymph node metastasis (cN0). When classified into types, there were 2 cases of type I (3%),15 cases of type II (22.3%), 34 cases of type III (50.7%), 4 cases of type IV (5.9%), 12 cases oftype V (17.9%). The local control rate and overall survival rate were calculated with Kaplan-Meier curve analysis. Additionally, multivariate analysis of factors associated with local recurrenceused Cox proportional-hazards model.
Results TLM alone was performed in 54 patients (80.5%) whereas 13 patients (19.5%) underwentTLM followed by adjuvant RT. The 5-year local control rate and 5-year overall survivalrate were 81.9% and 93.3%, respectively. In the Univariate analysis, the significant factors oflocal recurrence were difficult laryngeal exposure [odds ratio (OR)=22.8, 95% confidence interval(CI)=1.7-297.4, p-value=0.03], anterior commissure invasion (OR=17.2, 95% CI=1.9-154.7,p-value=0.004, positive lymphovascular invasion (OR=18.0, 95% CI=2.9-109.8, p-value=0.003)and positive resection margin (OR=9.5, 95% CI=1.6-55.6, p-value=0.011). In the multivariateanalysis, the independent factors of local recurrence were anterior commissure invasion [hazardratio (HR)=18.4, 95% CI=1.98-170.99, p-value=0.010] and lymphovascular invasion (HR=7.5,95% CI=1.49-38.15, p-value=0.015). No major or lethal complications were observed.
Conclusion TLM is a reliable modality to treat early and select cases of moderately advancedglottic cancer. Our study found that independent factors of local recurrence included anteriorcommissure invasion, and lymphovascular invasion. These findings may be useful to follow-upglottic cancer patients after TLM

영어초록

Background and Objectives Transoral laser microsurgery (TLM) is minimally invasive andhas become the standard approach for early and intermediate stage laryngeal cancers. Manystudies show that the oncologic results of TLM are equivalent to those obtained by conventionalconservative surgery and radiotherapy (RT). The purpose of this study were to analyze the treatmentoutcome and predictors of local recurrence in glottic cancer patients who underwent TLM.
Subjects and Method Sixty-seven patients who received TLM for glottis cancer between2008 and 2019 were analyzed retrospectively. Patients were predominantly male (98.5%), witha median age of 64.3 years (range 45 to 87 years). There were 35 cases of T1 (52.2%), 15 casesof T2 (22.3%), and 17 cases of T3 (25.3%) in the primary tumor stage. There were no patientswith lymph node metastasis (cN0). When classified into types, there were 2 cases of type I (3%),15 cases of type II (22.3%), 34 cases of type III (50.7%), 4 cases of type IV (5.9%), 12 cases oftype V (17.9%). The local control rate and overall survival rate were calculated with Kaplan-Meier curve analysis. Additionally, multivariate analysis of factors associated with local recurrenceused Cox proportional-hazards model.
Results TLM alone was performed in 54 patients (80.5%) whereas 13 patients (19.5%) underwentTLM followed by adjuvant RT. The 5-year local control rate and 5-year overall survivalrate were 81.9% and 93.3%, respectively. In the Univariate analysis, the significant factors oflocal recurrence were difficult laryngeal exposure [odds ratio (OR)=22.8, 95% confidence interval(CI)=1.7-297.4, p-value=0.03], anterior commissure invasion (OR=17.2, 95% CI=1.9-154.7,p-value=0.004, positive lymphovascular invasion (OR=18.0, 95% CI=2.9-109.8, p-value=0.003)and positive resection margin (OR=9.5, 95% CI=1.6-55.6, p-value=0.011). In the multivariateanalysis, the independent factors of local recurrence were anterior commissure invasion [hazardratio (HR)=18.4, 95% CI=1.98-170.99, p-value=0.010] and lymphovascular invasion (HR=7.5,95% CI=1.49-38.15, p-value=0.015). No major or lethal complications were observed.
Conclusion TLM is a reliable modality to treat early and select cases of moderately advancedglottic cancer. Our study found that independent factors of local recurrence included anteriorcommissure invasion, and lymphovascular invasion. These findings may be useful to follow-upglottic cancer patients after TLM

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