Clinical outcomes of 849 laryngeal cancers treated in the past 40 years: Are we succeeding?
Clinical outcomes of 849 laryngeal cancers treated in the past 40 years: Are we succeeding?
复制标题
过去 40 年来治疗的 849 例喉癌的临床结果：我们成功了吗？
作者：
Nakayama;M.;Okamoto;M.;Hayakawa;K.;Miyamoto;S.;Ishiyama;H.;Komori;S.;Okamoto;T.;Seino;Y.;Kano;K. Soda;I.;Sekiguchi;A.;Kawakami;S.
方法将849例喉癌患者按登记年份分为1972-82、1983-92、1993-2002和2003-12四组，比较其治疗效果。结果1972 ~ 1982年、1983 ~ 1992年、1993-2002年和2003 ~ 2012年分别登记了104例、173例、253例和319例患者。1972- 1982年、1983- 1992年、1993-2002年和2003- 2012年的五年总生存率分别为74%、76.5%、75.6%和82.2%。在1972-82年，1983-92年，1993-2002年和2003-12年，五年的喉保存率分别为65.5，75.7，75.4和80.9%，分别。在非手术治疗方案分析中，S1联合放疗在喉保护方面优于同步放化疗和放疗，S1联合放疗、同步放化疗和替加氟尿嘧啶联合放疗在总生存率方面优于放疗。在非手术方法中，正确的病例选择是成功的关键，可能比追求放疗剂量增加更重要。在手术选择的分析中，激光和环状软骨上喉切除术联合环舌骨会厌固定术分别有助于早期和中期癌症的喉保留。环状软骨上喉切除术和环舌骨会厌固定术的总体生存率并不比全喉切除术差，这是保留喉的先决条件。我们必须做出额外的努力，在非手术和手术保留喉的选择之间寻求一个理想的平衡。
ObjectiveWe analyzed the clinical outcomes of 849 laryngeal cancers treated in the past 40 years, which overlapped with the era of the global treatment shift.MethodsTo compare the chronological outcomes, patients were divided into four groups according to their registration year as 1972–82, 1983–92, 1993–2002 and 2003–12; treatment trends, larynx preservation rate and overall survival rate were compared.ResultsThere were 104, 173, 253 and 319 patients registered in 1972–82, 1983–92, 1993–2002 and 2003–12, respectively. Five-year overall survival rates were 74, 76.5, 75.6 and 82.2% in 1972–82, 1983–92, 1993–2002 and 2003–12, respectively. The five-year larynx preservation rates were 65.5, 75.7, 75.4 and 80.9% in 1972–82, 1983–92, 1993–2002 and 2003–12, respectively.ConclusionsThe number of patients treated at our institute increased, and the overall survival and larynx preservation rates exhibited favorable improvements over the past four decades. In the analysis of nonsurgical options, S1 combined radiotherapy showed superiority over concurrent chemoradiotherapy and radiotherapy in larynx preservation, and S1 combined radiotherapy, concurrent chemoradiotherapy and Tegafur Uracil combined radiotherapy showed superiority over radiotherapy in overall survival. In nonsurgical approaches, proper case selection is the key to success and may be much more important than pursuing radiotherapy dose escalation. In the analysis of surgical options, laser and supracricoid laryngectomy with cricohyoidoepiglottopexy contributed to larynx preservation in early- and intermediate-stage cancers, respectively. Supracricoid laryngectomy with cricohyoidoepiglottopexy demonstrated overall survival not worse than total laryngectomy, which is the prerequisite treatment basis for larynx preservation options. We must make extra efforts in pursuing an ideal balance between nonsurgical and surgical larynx preservation options.