| Objective:Laryngeal carcinoma is one of the common malignant tumors of the head and neck.The main pathological type is squamous cell carcinoma.At present,the clinical treatment of laryngeal carcinoma is surgery-based comprehensive treatment.In recent years,despite the continuous improvement of laryngeal carcinoma surgery,the long-term survival rate of patients has not significantly improved,and tumor recurrence and metastasis are still the main cause of patient death.Therefore,this article compares the clinical efficacy of different surgical methods for patients with laryngeal carcinoma,to explore the relevant factors affecting the prognosis of patients with laryngeal carcinoma,and provide clinical basis for the choice of surgical treatment and prognosis of patients with laryngeal carcinoma.Methods:Retrospective analysis of clinical cases of patients with laryngeal carcinoma who were first treated in the Department of Otorhinolaryngology Head and Neck Surgery of the Affiliated Hospital of Southwest Medical University from January 2013 to October 2018 were analysized.They were mainly followed up by case review,outpatient review or phone to learn the general situation,tumor characteristics,surgical treatments,recovery of swallowing function and respiratory function,surgical-related complications,postoperative recurrence and metastasis,and survival.Comparative analysis of surgical methods,recovery of breathing and swallowing function,retention of larynx function,and complications in patients with laryngeal carcinoma.The effects of two surgical methods on the prognosis of early glottic laryngeal carcinoma,tumor location,clinical stage,cervical lymph node metastasis,and anterior laryngeal lymph node metastasis were compared and analyzed,and nine clinical indicators such as age,sex,tumor location,degree of pathological differentiation,clinical stage,T stage,N stage,surgical method,and lymph node metastasis were selected as the single factor influencing the prognosis of the patient based on the characteristics of the literature and the characteristics of this group index.After excluding factors such as clinical stage and cervical lymph node metastasis based on univariate analysis results,multivariate analysis of the impact of three factors including tumor site,surgical method,and N stage on the prognosis of patients with laryngeal carcinoma.SPSS 20.0 software was used to statistically analyze the data.Qualitative data were described by frequency and percentage.Quantitative data were described by mean and standard deviation(x±s).Chi-square test was used to compare differences between groups of qualitative data.Log-rank test or?~2 test was used to analyze the one-way ANOVA of the prognosis of patients with laryngeal carcinoma,and Cox proportional analysis risk model was used to analyze the multi-factor ANOVA of the prognosis of the patients with laryngeal cancer.P<0.05 was considered as statistically,and Kaplan-Meier method was used for survival analysis.Results:(1)A total of 171 cases met the criteria,including 166 males with an average age of 59 years,and 5 females with an average age of 50 years.According to the primary tumor site,133 cases were glottic,32 cases were supraglottic,1 case was subglottic,and 5 cases were tranglottic.136 cases of highly differentiated squamous cell carcinoma,31 cases of moderately differentiated squamous cell carcinoma,4 cases of poorly differentiated squamous cell carcinoma.According to the 2009 UICC(Union For International Cancer Control)TNM staging criteria,76 cases were in stage?,43cases in stage?,30 cases in stage?,and 22 cases in stage?.Laser surgery under supporting laryngoscope in 49 cases,partial laryngectomy in 89 cases,and total laryngectomy in 33 cases.Partial laryngectomy included 34 cases of laryngeal fissure resection.Vertical hemi-laryngectomy was performed in 35cases.Horizontal hemi-laryngectomy was performed in 3 cases.There were 17cases of SCPL(Supracricoid Partial Laryngectomy),including 15 cases of CHEP(Cricohyoidopiglottpexy),1 cases of CHP(Cricohyoidopexy),and 1case of TCHEP(Tracheocricohyoidopiglottpexy).And 24 cases of unilateral dissection,and 47 cases of bilateral dissection.Pathologically confirmed postoperative cervical lymph node metastases in 27 cases,of which 9 were glottic,17 were supraglottic,and 1 was transglottic.The cervical lymph node metastasis of supraglottic cancer was as follows:a total of 104 metastatic lymph nodes were found in areas?(41,39.4%),?(39,37.5%),?(21,20.2%),and?(3,2.9%).Patients with laryngeal carcinoma with zone?metastasis accompanied by lymph node metastasis in zone?and/or?.(2)Recovery of swallowing function:Patients in the laser surgery group had no difficulty swallowing and had a good swallowing function.The gastric tube was successfully removed in the laryngectomy group and the total laryngectomy group,all the patients restore swallowing function after extubation.(3)Recovery of respiratory function:Patients in the laser surgery group had no dyspnea after surgery and had a good breathing function.One patient in the vertical hemi-laryngectomy group could not remove the tracheal cannula due to postoperative laryngeal stenosis,and 8 patients failed to remove the tube due to postoperative chemoradiotherapy laryngeal stenosis and extubation rate was75.7%(28/37).One patient in the CHEP group failed to be extubated due to postoperative chemoradiotherapy laryngeal stenosis and the extubation rate was93.8%(15/16).The tracheal cannula was successfully removed in laryngeal fissure vocalectomy,horizontal hemi-laryngectomy,CHP and TCHEP.(4)Laryngeal function retention in advanced laryngeal carcinoma:fifty-two cases of advanced laryngeal carcinoma were treated with laryngeal function preservation in 17 cases.The laryngeal function retention rate was 32.7%(17/52).The 3-year and 5-year survival rates of the laryngeal function retention group were 81.6%and 60.4%,respectively.And the 3-year and 5-year survival rates of the non-preserved laryngeal function group were 76.0%and 58.8%,respectively.There was no significant difference between the two groups(P=0.6790).(5)Complications:The overall incidence of postoperative complications was 17.5%(30/171),including 2 cases of pulmonary infection,12 cases of neck incision infection,6 cases of pharyngeal fistula,9 cases of laryngeal fistula,and 1 case of larynx stenosis.There were no complications such as subcutaneous emphysema,bleeding,and dyspnea in the laser surgery group,and the complication rate was 0%(0/49).The complication rate in the partial laryngectomy group was 21.4%(19/89),including 3 cases of neck incision infection,and 4 cases of laryngeal fistula with laryngeal fissure resection.2 cases of neck incision infection,4 cases of laryngeal fistula,and 1case with larynx stenosis with vertical hemi-laryngectomy.1 case of neck incision infection with hemi-laryngectomy.1 case of neck incision infection,2cases of pharyngeal fistula and 1 case of laryngeal fistula with CHEP.The incidence of complications in the total laryngectomy group was 33.3%(11/33),including 2 cases of lung infection,5 cases of neck incision infection,and 4cases of pharyngeal fistula,there was no significant difference in the incidence of complications between the two groups(P=0.1720),and the difference in the incidence of complications between different laryngectomy methods was not statistically significant(P=0.9110).(6)The 1-year 3-year and 5-year survival rates of support laryngoscope laser surgery and partial laryngectomy for early glottic laryngeal carcinoma were 97.9%?86.3%?80.6%and 96.8%?93.5%?88.0%,and the 1-year,3-year,and 5-year survival rates of the two groups were not statistically significant(P value are all>0.05).Recurrence rates in the two groups were 30.6%(15/49)and 6.6%(4/61),the difference in recurrence rates between the two groups was statistically significant(P=0.0010).(7)The 1-year3-year and 5-year survival rates of support laryngoscope laser surgery and partial laryngectomy for early-stage glottic laryngeal carcinoma which involves the anterior commissure were 88.4%?67.0%?59.0%and 93.1%?88.0%?86.2%,and the 1-year,3-year,and 5-year survival rates of the two groups were statistically significant(P value are all<0.05).The recurrence rates were50.0%(6/12)and 7.8%(4/51),and the difference between the two groups was statistically significant(P=0.0020).(8)The 1-year,3-year and 5-year survival rates of glottic and supraglottic laryngeal carcinoma were 98.5%,88.6%,78.5%and 96.9%,75.0%,61.4%,the 1-year,3-year,and 5-year survival rates of the two groups were statistically significant(P value are all<0.05).(9)The 1-year,3-year and 5-year survival rates of eraly stage laryngeal cancer(?+?)and the advanced stage laryngeal cancer(?+?)were 99.1%,92.1%,83.1%and96.2%,70.5%,57.7%,and the 1-year,3-year,and 5-year survival rates of the two groups were statistically significant(P value are all<0.05).(10)The 1-year,3-year and 5-year survival rates of negative lymph node metastasis group were99.3%,91.2%and 82.8%,respectively,the lymph node metastasis 1-year,3-year and 5-year survival rates were 96.0%,54.5%and 38.1%,and the 1-year,3-year,and 5-year survival rates of the two groups were statistically significant(P value are all<0.05).(11)The 1-year,3-year and 5-year survival rates of negative laryngeal lymph nodes were 98.8%,85.6%and 75.1%,respectively,the positive laryngeal lymph nodes 1-year,3-year and 5-year survival rates were 80.0%,80.0%and 80.0%,and the 1-year,3-year,and 5-year survival rates of the two groups were not statistically significant(P value are all>0.05).(12)Stage of laryngeal carcinoma was statistically significant difference in cervical lymph node metastasis(P=0.0100),but the degree of differentiation was not statistically significant difference in cervical lymph node metastasis(P=0.4210).(13)5 cases of positive laryngeal lymph node metastasis and 2 cases of positive cervical lymph node metastasis with 40.0%(2/5)transfer rate.Recurrence occurred in 1 case after operation,and the recurrence rate was 20.0%(1/5).117cases of negative laryngeal lymph node metastasis and 22 cases of positive cervical lymph node metastasis with 18.8%(22/117)transfer rate.Recurrence occurred in 18 case after operation,and the recurrence rate was 15.4%(18/111).There was no significant difference in cervical lymph node metastasis between the anterior laryngeal lymph node positive group and the negative group(P=0.2430),and the difference in postoperative recurrence rate was not statistically significant(P=0.7800).(14)There were 11 cases of recurrence in the positive cervical lymph node metastasis group with recurrence rate of45.8%(11/24),and 8 cases in the negative group with recurrence rate of 8.2%(8/98),the difference in recurrence rate between the two groups was statistically significant(P<0.0001).(15)Univariate analysis suggested tumor primary site,clinical stage,N stage,and surgical method and lymph node metastasis were impact factors for survival status of laryngeal cancer(P value are all<0.05).The effects of age,gender,degree of pathological differentiation,and T stage on the prognosis were not statistically significant(P value are all>0.05).Multivariate analysis revealed that N stage was an independent risk factor affecting the prognosis of patients with laryngeal carcinoma(P<0.0001).Conclusion:(1)Choosing surgical treatment according to the tumor site,affected area,and clinical stage individualization.Some advanced patients can retain the laryngeal function without reducing the survival rate of the patient under the condition that the tumor is completely removed.(2)For early glottic laryngeal carcinoma,open partial laryngectomy surgery can reduce the risk of tumor recurrence compared compared with support laryngoscope laser surgery,and for early glottic laryngeal carcinoma that involved aggressive anterior commissure,open partial laryngectomy surgery has better prognosis than support laryngoscope laser surgery.(3)Supraglottic laryngeal carcinoma is more prone to cervical lymph node metastasis,and lymph node metastasis often metastasizes to areas?and?.When performing cervical lymph node dissection,lymph node dissection of the above areas should be routinely included.(4)The higher the T stage,the more likely the cervical lymph nodes to metastasize,patients with lymph node metastasis have a worse prognosis and are more likely to relapse than patients without lymph node metastasis.In the advanced stage of laryngeal carcinoma,the neck lymph nodes must be normatively cleaned up while the primary lesions are completely removed;(5)The main factors affecting the prognosis of laryngeal cancer include tumor primary site,clinical stage,N stage,surgical method and lymph node metastasis,and N-stage is an independent risk factor affecting the prognosis of laryngeal cancer. |
PDF Full Text Request