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
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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
Abstract
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
참고문헌 (30)
- Montgomery WW, "Salivary bypass tube", Ann Otol Rhinol Laryngol, 87(2 Pt 1), pp.159~162 (1978)
- Strong MS, "Laser surgery in the larynx. Early clinical experience with continuous CO 2 laser", Ann Otol Rhinol Laryngol, 81(6), pp.791~798 (1972)
- 박지훈, "초기 성문암에서 레이저 성대절제술과 방사선치료 결과", 대한이비인후-두경부외과학회지, 45(2), pp.159~163 (2002), 대한이비인후과학회
- 태경, "조기 성무암종에서 경구강 CO₂레이저 성대절제술의 의의", 대한이비인후-두경부외과학회지, 49(5), pp.538~542 (2006), 대한이비인후과학회
- Steiner W, "Results of curative laser microsurgery of laryngeal carcinomas", Am J Otolaryngol, 14(2), pp.116~121 (1993)
- Eckel HE, "Local recurrences following transoral laser surgery for early glottic carcinoma: Frequency, management, and outcome", Ann Otol Rhinol Laryngol, 110(1), pp.7~15 (2001)
- Rudert HH, "Endoscopic resections of glottic and supraglot tic carcinomas with the CO2 laser", Eur Arch Otorhinolaryngol, 252(3), pp.146~148 (1995)
- Vilaseca I, "Transoral laser microsurgery for T3 laryngeal tumors: Prognostic factors", Head Neck, 32(7), pp.929~938 (2010)
- Canis M, "Results of 226 patients with T3 laryngeal carcinoma after treatment with transoral laser microsurgery", Head Neck, 36(5), pp.652~659 (2014)
- Harwood AR, "T3 glottic cancer: An analysis of dose time-volume factors", Int J Radiat Oncol Biol Phys, 6(6), pp.675~680 (1980)
- Jørgensen K, "Cancer of the larynx--treatment results after primary radiotherapy with salvage surgery in a series of 1005 patients", Acta Oncol, 41(1), pp.69~76 (2002)
- Parsons JT, "Twice-a-day radiotherapy for T3 squamous cell carcinoma of the glottic larynx", Head Neck, 11(2), pp.123~128 (1989)
- Wylie JP, "Definitive radiotherapy for 114 cases of T3N0 glottic carcinoma:Influence of dose-volume parameters on outcome", Radiother Oncol, 53(1), pp.15~21 (1999)
- Fu X, "Efficacy comparison between total laryngectomy and nonsurgical organ-preservation modalities in treatment of advanced stage laryngeal cancer: A meta-analysis", Medicine(Baltimore), 95(14), pp.e3142~ (2016)
- 김보해, "Comparison of Treatment Outcomes for T3 Glottic Squamous Cell Carcinoma: A Meta-Analysis", Clinical and Experimental Otorhinolaryngology, 11(1), pp.1~8 (2018), 대한이비인후과학회[DOI]
- 정필상, "T1 성문암에서 방사선치료와 레이저 성대절제술의 비교분석", 대한이비인후-두경부외과학회지, 48(9), pp.1161~1165 (2005), 대한이비인후과학회
- Cragle SP, "Laser cordectomy or radiotherapy:Cure rates, communication, and cost", Otolaryngol Head Neck Surg, 108(6), pp.648~654 (1993)
- de Campora E, "External versus endoscopic approach in the surgical treatment of glottic cancer", Eur Arch Otorhinolaryngol, 258(10), pp.533~536 (2001)
- Thomas JV, "Early glottic carcinoma treated with open laryngeal procedures", Arch Otolaryngol Head Neck Surg, 120(3), pp.264~268 (1994)
- Casiano RR, "Laser cordectomy for T1 glottic carcinoma : A 10-year experience and videostroboscopic findings", Otolaryngol Head Neck Surg, 104(6), pp.831~837 (1991)
- Gallo A, "CO2 laser cordectomy for early-stage glottic carcinoma : A long-term follow-up of 156 cases", Laryngoscope, 112(2), pp.370~374 (2002)
- Ramakrishnan Y, "Oncologic outcomes of transoral laser microsurgery for radiorecurrent laryngeal carcinoma : A systematic review and meta-analysis of English-language literature", Head Neck, 36(2), pp.280~285 (2014)
- Puxeddu R, "Carbon dioxide laser salvage surgery after radiotherapy failure in T1 and T2 glottic carcinoma", Otolaryngol Head Neck Surg, 130(1), pp.84~88 (2004)
- Ansarin M, "Retrospective analysis of factors influencing oncologic outcome in 590 patients with early-intermediate glottic cancer treated by transoral laser microsurgery", Head Neck, 39(1), pp.71~81 (2017)
- Thomas JV, "Recurrences after endoscopic management of early(T1)glottic carcinoma", Laryngoscope, 104(9), pp.1099~1104 (1994)
- Wolfensberger M, "Endoscopic laser surgery for early glottic carcinoma: A clinical and experimental study", Laryngoscope, 100(10 Pt 1), pp.1100~1105 (1990)
- Chang CF, "Predictors of local recurrence of glottic cancer in patients after transoral laser microsurgery", J Chin Med Assoc, 80(7), pp.452~457 (2017)
- Peretti G, "Transoral CO(2) laser treatment for T(is)-T(3)glottic cancer: The University of Brescia experience on 595 patients", Head Neck, 32(8), pp.977~983 (2010)
- Ansarin M, "Laser surgery for early glottic cancer : Impact of margin status on local control and organ preservation", Arch Otolaryngol Head Neck Surg, 135(4), pp.385~390 (2009)
- Crespo AN, "Role of margin status in recurrence after CO2 laser endoscopic resection of early glottic cancer", Acta Otolaryngol, 126(3), pp.306~310 (2006)