Impact of Close and Positive Margins in Transoral Laser Microsurgery for Tis-T2 Glottic Cancer.
Impact of Close and Positive Margins in Transoral Laser Microsurgery for Tis-T2 Glottic Cancer.
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DOI：
10.3389/fonc.2017.00245
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发表时间：
2017
影响因子：
4.7
通讯作者：
Peretti G
中科院分区：
文献类型：
--
作者：
Fiz I;Mazzola F;Fiz F;Marchi F;Filauro M;Paderno A;Parrinello G;Piazza C;Peretti G
经口激光显微手术（TLM）是Tis-T2声门鳞状细胞癌（SCC）最有效的治疗策略之一。近缘/阳性切缘对预后的影响仍有争议，术中窄带成像（NBI）在其定义中的作用仍有待在大量患者中验证。本研究分析了切缘状态对无复发生存期（RFS）和疾病特异性生存期（DSS）的影响。我们回顾性研究了507例pTis-T1b （A组）和127例pT2 （B组）声门SCC。我们确定了以下切缘状态：阴性（n = 232）、近浅切（n = 79）、近深切（CD） （n = 35）、单浅切阳性（n = 146）、多浅切阳性（n = 94）和深切阳性（n = 48），并分析了它们对RFS和DSS的影响。肿瘤边缘距离< 1mm为近缘。323例患者采用白光定义tlm前边缘，而311例患者采用NBI。A组阳性多个浅缘和深缘的DSS和RFS降低（DSS = 96.1和97%，p < 0.05; RFS = 72%, p < 0.001和75.8%,p < 0.01）。B组阳性多个表缘DSS降低（82.4%,p < 0.05）。阳性单浅表切缘、阳性多发浅表切缘和阳性深切缘的RFS降低（62.5%、41.2%和53.3%,p < 0.01）。在整个人群中，CD边缘的RFS降低（77.1%,p < 0.05）。NBI的使用改善了RFS和DSS。研究表明闭合和阳性的单浅表缘不影响DSS。相比之下，所有类型的切缘阳性预测复发的发生，尽管根据阶段/切缘类型有不同的可能性。大额存单保证金应被视为单一风险因素。使用NBI可以更好地定义术中边缘。
Transoral laser microsurgery (TLM) represents one of the most effective treatment strategies for Tis–T2 glottic squamous cell carcinomas (SCC). The prognostic influence of close/positive margins is still debated, and the role of narrow band imaging (NBI) in their intraoperative definition is still to be validated on large cohort of patients. This study analyzed the influence of margin status on recurrence-free survival (RFS) and disease-specific survival (DSS). We retrospectively studied 507 cases of pTis–T1b (Group A) and 127 cases of pT2 (Group B) glottic SCC. We identified the following margin status: negative (n = 232), close superficial (n = 79), close deep (CD) (n = 35), positive single superficial (n = 146), positive multiple superficial (n = 94), and positive deep (n = 48) and analyzed their impact on RFS and DSS. Close margins were defined by tumor-margin distance <1 mm. Pre-TLM margins were defined by white light in 323 patients, whereas NBI was employed in 311 patients. In Group A, DSS and RFS were reduced in positive multiple superficial and positive deep margins (DSS = 96.1 and 97%, both p < 0.05; RFS = 72%, p < 0.001 and 75.8%, p < 0.01). In Group B, DSS was reduced in positive multiple superficial margins (82.4%, p < 0.05). RFS was reduced in positive single superficial, positive multiple superficial, and positive deep margins (62.5, 41.2, and 53.3%, p < 0.01). In the entire population, RFS was reduced in CD margins (77.1%, p < 0.05). Use of NBI led to improvement in RFS and DSS. The study indicates that close and positive single superficial margins do not affect DSS. By contrast, all types of margin positivity predict the occurrence of relapses, albeit with different likelihood, depending on stage/margin type. CD margins should be considered as a single risk factor. Use of NBI granted better intraoperative margins definition.
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影响因子：
6.2
作者：
Misono S;Marmor S;Yueh B;Virnig BA
通讯作者：
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影响因子：
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DOI：
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