Ⅳ期声门上型喉癌的治疗与预后

目的探讨Ⅳ期声门上型喉癌的治疗方式以及颈淋巴结、切缘状态对预后的影响。方法回顾性研究85例Ⅳ期声门上型喉癌的临床资料，运用Cox模型分析影响预后的临床病理因素；分析不同治疗方式、颈淋巴结及切缘状态对预后的影响；了解Ⅳ期声门上型喉癌的生存情况。结果Ⅳ期声门上型喉癌总3、5年生存率为37．7％（38／85）、30．4％（25／85）；采用不同治疗方式（单纯手术，放疗＋挽救手术，手术＋术后放疗，、化疗＋放疗及单纯化疗）治疗的患者，其生存率比较均无显著性差异（P=0．8260）；初治有淋巴结转移者（cN＋）预后差（P=0．0233）；cN0出现隐性淋巴结转移者与未出现隐性淋巴结转移者生存率比较无显著性差异（P=0．0141）；切缘阳性者术后放疗同阴性者相比，其生存率比较无显著性差异（P=0．8913）；Cox模型分析显示：仅N分期是影响预后的独立因素（P=0．0290）。结论Ⅳ期声门上型喉癌预后差，生存率低；不同治疗方式对生存率无影响；N分期是影响预后的独立因素，初治cN＋及cN0出现隐性淋巴结转移预后差；切缘阳性术后放疗生存率不降低。     

声门型喉癌的治疗

目的 分析声门型喉癌在不同治疗方式下的预后及其影响预后的因素。方法 212例声门型喉癌分为三组，即手术组，放疗组和手术加放疗组，所有病例又按是否侵犯前联合分为两组。结果 三组的五年生存率分别为76％，80％和73％。按是否侵犯前联合分组的分别是65％和88％。结论 无论采用何种方法治疗，声门型喉癌都有较好的预后，而是否侵犯前联合则是影响预后的关键。     

声门上水平部分喉切除术治疗声门上喉癌T3病变

按照UICC1997年的分期标准,声门上喉癌T3病变侵犯范围变化较大,手术治疗存在一定的复杂性.目前有多种可供选择的手术方式,但各种术式的手术适应证不够明确[1].本文回顾我院应用声门上水平部分喉切除术治疗声门上喉癌T3病变的效果,讨论并分析手术的适应证以及对T3病变的临床处理方法.     

148例声门型喉癌的治疗选择

目的探讨声门型喉癌的手术治疗.方法对1988年5月至1991年5月期间在华西医科大学附一院初诊的148例声门型喉癌作了调查.结果148例患者中有18例放弃治疗,99例声门型喉癌患者行部分喉切除术,部分喉切除术占手术病员80.5%(99/123),共有62例患者随访满5年,切缘有癌4例,局部复发死亡2例(50.0%),58例切缘元癌,因癌死亡9例,占15.8%(9/57),因心脏病死亡1例.结论喉部分切除术是功能保全性喉部恶性肿瘤根治的有效术式,但需保证切缘无癌.     

声门型喉癌的治疗

目的　分析声门型喉癌在不同治疗方式下的预后及其影响预后的因素。方法　 2 12例声门型喉癌分为三组 ,即手术组 ,放疗组和手术加放疗组 ,所有病例又按是否侵犯前联合分为两组。结果　三组的五年生存率分别为 76% ,80 %和 73 %。按是否侵犯前联合分组的分别是 65 %和 88%。结论　无论采用何种方法治疗 ,声门型喉癌都有较好的预后 ,而是否侵犯前联合则是影响预后的关键。     

声门上喉癌的手术治疗(附182例报告)

目的 探讨声门上喉癌手术治疗的方法及其疗效。方法 对182例声门上喉癌患者进行手术治疗。按1997年UICC修订案分期,I期11例,Ⅱ期45例,Ⅲ期49例,Ⅳ期77例。根据病变情况不同,采用相应的切除及修复方式。结果 全组喉部分切除术占78．6％（143／182）;Ⅲ、Ⅳ期患者中,喉部分切除术占69．8％（88／126）。喉部分切除术拔管率为81．8％（117／143）。全组患者3,5年生存率分别为82．9％和67．3％,Ⅲ、Ⅳ期喉部分切除术患者的3,5年生存率分别为76．9％和57．4％,Ⅲ、Ⅳ期全喉切除术患者的3,5年生存率分别为82．5％和67．0％。Ⅲ、Ⅳ期喉部分切除术与全喉切除术患者的生存率差异无显著性（P＞0．05）。结论 晚期声门上喉癌保留喉功能是可行的。熟练掌握多各修复方法,择优采用,可提高喉功能的保留率。     

早期声门型喉癌放疗与手术治疗的疗效分析

167 patients with early glottic carcinoma treated by surgery or radiotherapy in the past 25 years are analysed. Of these patients, 74 with T1 N0 M0 glottic carcinoma treated by surgery gave a 5-year survival rate of 93.2%. In these 74 patients, 5 who received total laryngectomy and 69, partial laryngectomy gave 5-year survival rates of 80% and 94.2%. In this series, 93 patients treated by radiotherapy gave a 5-year survival rate of 87.4%. There was no significant difference between the two groups (X2 test P greater than 0.05). The above results showed that the results of surgery and radiotherapy are similar. The authors suggest that radiotherapy be considered as the first choice for this type of cancer for its advantages over surgery.     

平消胶囊对声门上型喉癌术后的疗效

目的比较手术加单纯口服平消胶囊与手术加辅助放疗对声门上型喉癌的疗效。方法对本院收治的84例患者分为治疗组与对照组,分别观察分析局部原发灶及颈部转移淋巴结的控制,并采用Kaplan-Meier比较两组生存率。结果本组病例总体5年生存率为41.7％,原发灶控制率为47.6％,颈部淋巴结控制率为56％,但两组之间的比较,包括在原发灶、转移灶的控制及生存率,均无显著性差异(P＞0.05)结论术后辅助放疗与加服平消胶囊可以取得相似的疗效。     

声门上喉癌隐性颈淋巴结转移对预后的影响

探讨声门上喉癌隐性颈淋巴结转移对预后的影响。方法：回顾性分析１２９例声门上喉癌的病例资料,分组统计预后,结果：声门上喉癌颈淋巴结转移组与隐性颈淋巴结转移组二者预后无差异;Ｎ０病例中有无隐性颈淋巴结转移两组预后差异显著。     

声门下区喉癌的临床特点与手术治疗

目的 探讨声门下区喉癌的临床特点和治疗手段。方法 7例46-74岁（平均62.5岁）原发声门下区喉癌,分期为T2N0M02例,T3N1M03例,T3N0M01例,T4N1M01例。对其临床特点、治疗方法、预后等方面进行分析。结果 声门下区癌发病率低,气管造口复发率高,声门下区癌T3、T4病变者宜全喉切除。T1、T2病变者作声门下区部分切除预后同样好。结论声门下区癌易向气管旁淋巴结、喉前淋巴结转移。术中应注意这些淋巴结的清扫。术后放疗对肿瘤的复发和转移是一种有效的辅助治疗。     

颈清扫术在声门上型喉癌治疗中的作用

目的 探讨颈清扫术在声门上型喉癌治疗中的作用.方法 总结448例声门上型喉癌患者的临床治疗及生存情况,其中T12例,T2175例,T3 140例,T4 131例.N+173例,占声门上型喉癌的38.6％.采用喉部分切除术173例,喉全切除术275例.同期颈清扫术396例(88.4％)(单侧168例,双侧228例).223例N0病例行改良全颈清扫术,173例N+病例行经典全颈清扫术,52例N0患者未行颈清扫术.结果 直接法统计其3年生存率为75.2％(337/448),5年生存率为52.2％(234/448).N0患者3年生存率为78.9％ (217/275),5年生存率为69.8％(192/275).N+患者3年生存率为69.4％ (120/173),5年生存率为24.3％(42/173),二者比较差异均有统计学意义(P＜0.05,P＜0.01).Ⅰ、Ⅱ期123例,Ⅲ、Ⅳ期325例,5年生存率分别为76.4％ (94/123)及43.1％(140/325),二者差异有统计学意义(P＜0.01).在颈部转移二次住院手术的44例中,其5年生存率仅为34.1％(15/44).结论 喉癌早期病例疗效明显好于晚期病例.声门上型喉癌N0时同期行必要的择区性颈清扫术是提高疗效的重要措施.     

Surgical Management of Supraglottic Laryngeal Carcinoma in Patients with Special Emphasis on Functional Preservation

OBJECTIVE To explore the surgical methods and evaluate the long-term results of laryngectomy in patients with supraglottic laryngeal cancer.METHODS A total of 182 patients with supraglottic laryngeal carcinoma underwent an operation from 1979 to 1999. These cases comprised 11 in stage Ⅰ , 45 in stage Ⅱ , 49 in stage Ⅲ and 77 in stage Ⅳ. The choice of surgical procedure was decided based on the condition of the diseasedl arynx. The surgical procedures proposed by TD Wang were adhered to as follows: minor partial laryngectomy 36, major partial laryngectomy 85,subtotal partial laryngectomy with laryngoplasty 22 and total larygectomy 39.RESULTS The final rate of larynx preservation was 78.6% (143/182) and 69.8% (88/126) in patients with stage III and IV diseases. The extubation rate was 81.8% in cases with preservation of laryngeal function. The overall 3-and 5-year survival rates were 82.9% and 67.3%, with 76.88% and 57.4% in the advanced (stage III and IV) cases who survived with preserved laryngeal function, and 82.5% and 67.0% in similar advanced cases who were treated by total laryngectomy. The difference in the survival rates between these 2 groups was not statistically significant.CONCLUSION It is suggested that preservation of the laryngeal function is possible for advanced supraglottic laryngeal carcinoma without compromising the long-term survival rate. To improve the rate of larynx preservation, one should follow the surgical methods suggested.     

Surgical management of the neck in squamous cell carcinoma of the floor of the mouth

Nodal involvement in squamous cell carcinoma considerably lowers survival rate. Despite its importance, neck management has still not been adequately explored. The Authors have retrospectively reviewed the records of 112 cases. Unilateral N+ were treated with a homolateral therapeutic and a controlateral prophylactic neck dissection; bilateral N+ were treated with a bilateral therapeutic neck dissection. On first observation the majority of cases (66.1%) were T1–2. N+ patients accounted for 45.5%. Among N− patients, 21.3% of occult nodal metastases were observed. The 5-year survival rate was 52.7%. With N+ lesions, a radical neck dissection should be performed; the dissection should be performed bilaterally. With N− lesions a prophylactic modified radical neck dissection is recommended in T2–4 lesions.     

Leptomeningeal carcinomatosis from squamous cell carcinoma of the supraglottic larynx

Leptomeningeal carcinomatosis is an uncommon but devastating form of metastatic spread. To our knowledge, only 16 cases originating from a head and neck cancer have been reported. We describe the first case of a patient with leptomeningeal carcinomatosis arising from a laryngeal squamous cell carcinoma. Shortly after completing treatment for an advanced supraglottic laryngeal cancer, this 63‐year‐old man presented with lower limb neurological symptoms and signs. Radiological and cytological evidence of leptomeningeal carcinomatosis of the distal spinal canal was identified. He was treated with intrathecal methotrexate and palliative radiotherapy. Although his pain improved, his lower limb weakness worsened. He died 3 weeks after completing radiotherapy. Presumed mode of spread was via the haematogenous route. The natural history and management of leptomeningeal carcinomatosis are discussed. Clinicians should be aware of the uncommon possibility of leptomeningeal carcinomatosis in a patient presenting with an appropriate constellation of symptoms and signs, and a past history of cancer.     

P53 expression in squamous cell carcinomas of the supraglottic larynx and its lymph node metastases: new results for an old question

BACKGROUND: Although p53 overexpression is frequent in head and neck squamous cell carcinomas (HNSCCs), controversy remains regarding the prognostic significance of that overexpression. The objective of this study was to investigate the expression pattern and prognostic significance of p53 expression in HNSCC of the same location, treated in the same way, and with long-term follow-up. METHODS: P53 expression was determined by immunohistochemistry in paraffin-embedded tissue specimens from 107 consecutive patients (107 primary squamous cell carcinomas of the supraglottic larynx and 46 matched lymph node metastases). All patients underwent surgical resection and bilateral neck dissection. RESULTS: A strong correlation was observed between p53 expression in the primary tumor and in the matched lymph node metastases (P=.0001). P53 overexpression in the lymph nodes was an independent predictor of regional recurrence (P=.027). Likewise, expression of p53 in the lymph nodes correlated significantly with disease-specific survival (P=.018). Five years after treatment, 70% of patients with p53-negative, metastatic lymph nodes remained alive, whereas only 30% of patients with p53-positive lymph nodes remained alive. In multivariate analysis, lymph node status and p53 expression in the lymph nodes remained associated with survival. CONCLUSIONS: The current data suggested that, although p53 overexpression is common in supraglottic carcinomas, its expression in the primary tumor is of limited clinical significance. However, the results supported the role of p53 in the lymph node metastases as an independent predictor of regional failure and a poor prognosis in patients with HNSCC. A prospective trial is indicated to validate these findings.     

Elective lateral neck dissection for laryngeal cancer in the clinically negative neck

BACKGROUND: Despite the introduction of modern imaging techniques, it is still difficult to detect microscopic disease in neck nodes. The purpose of this study is to evaluate the efficacy of the lateral neck dissection (LND) for elective treatment of the clinically node negative neck (cN0) in laryngeal squamous cell carcinoma (SCC). METHODS: The clinical records of 110 cN0 patients with laryngeal SCC treated in this hospital from January 1997 to December 2002 were reviewed retrospectively. RESULTS: One hundred ten patients received 145 elective LND. Occult metastasis was detected in 22 (20.0%) of this group of patients. The distribution of the 37 positive nodes was as follows: Level II 56.8%; Level III 37.8%; Level IV 5.4%. The 3-year neck recurrence rate estimated by the Kaplan-Meier approach for all cN0 patients (n = 110) was 5.4% [95% CI: 0.0%; 12.5%]. No significant difference in 3-year lymph node recurrence was found between node negative and node positive groups, between supraglottis and glottis groups, or between surgery alone and combined therapy groups. CONCLUSION: The lateral neck dissection is effective in elective treatment of the neck in patients with laryngeal carcinoma.     

A favorable subset of AJCC stage IV squamous cell carcinoma of the head and neck

AJCC (American Joint Committee on Cancer) Stage IV is subdivided into a relatively favorable subset, IVA, and an unfavorable subset IVB.     

Primary oat cell carcinoma of the larynx: A case history and literature review

A case of primary oat cell carcinoma of the larynx is described and the literature reviewed. The origin of this rare tumor and the natural history of the disease are discussed. The different treatment modalities carried out so far are described.     

Management of the clinically negative neck (N0) of supraglottic laryngeal carcinoma: A systematic review

Aim

The most effective therapeutic approach for patients with supraglottic laryngeal carcinoma (SGLC) and clinically negative neck (cN0) remains a subject of much debate. The purpose of this systematic review was to answer the following question: among patients with SGLC and cN0 neck, are the survival and occurrence of neck metastases significantly different between patients that received neck dissection and those that had another therapeutic treatment (radiotherapy, combined therapy, ‘wait and see’ policy)?

Materials and methods

An electronic literature search was performed in MEDLINE, EMBASE, Cochrane Library and CENTRAL databases, followed by extensive hand-searching for the identification of relevant studies.The following inclusion criteria were established: the study should (a) include a comparison of neck dissection with one of the other therapeutic procedures for cN0 of SGLC; (b) report the therapy for the initial supraglottic cancer; and (c) use time-to-event analysis of its results.Six studies were eventually identified and systematically reviewed.

Results

All studies included in the systematic review were retrospective (n = 792 patients). The survival (overall, disease-specific and neck disease-free) and the site of neck recurrence of the patients with N0 supraglottic cancer were not significantly different between patients in the neck dissection treatment group and those of the rest of the therapeutic strategies examined (neck radiotherapy, combined therapy and ‘wait and see’ policy).

Conclusions

The present systematic review highlights the need for further well-designed prospective studies that will provide more reliable answers to the debatable issue of the management of cN0 of SGLC. Currently, based on the best available evidence, it seems that neck dissection is not superior to radiotherapy or combined therapy or a ‘wait and see’ policy in terms of survival and control of neck disease.