文章：

全喉切除术或喉咽切除术患者手术切缘的临床相关性

Clinical Relevance of Resection Margins in Patients with Total Laryngectomy or Laryngopharyngectomy

原文发布日期：28 May 2024

DOI: 10.3390/cancers16112038

类型: Article

开放获取: 是

英文摘要：

Background: Laryngeal and hypopharyngeal cancer is complex and resection margins are therefore constrained. The aim of this study was to investigate the clinical relevance of resection margins in laryngeal and hypopharyngeal surgery. Methods: A retrospective cohort study was performed for patients treated with a total laryngectomy (TL) or laryngopharyngectomy (TLP) for laryngeal or hypopharyngeal squamous cell carcinoma (LSCC and HSCC, respectively). Within the groups primary LSCC, recurrent LSCC, primary HSCC, and recurrent HSCC the relationship between the status of the resection margin according to the Royal Collage of Pathology and the recurrence and survival rates were investigated. Results: Positive resection margins were found in 54% for primary LSCC, 29% for recurrent LSCC, 62% for primary HSCC, and 44% for recurrent HSCC. For primary and recurrent LSCC, there was a linear association between total recurrence and narrowing margins (p= 0.007 resp.p= 0.008). Multivariate survival analysis for primary and recurrent LSCC showed a significantly worse disease free and disease-specific survival in case of positive margins compared to clear margins. Conclusion: Similar survival rates were recorded for close and clear margins for primary and recurrent LSCC. This may suggest that a margin > 5 mm is not clinically relevant in terms of survival. Therefore, a margin of 1–5 mm should be accepted in certain subsites. Margins < 1 mm are related to significantly worse outcomes and should be avoided.

摘要翻译： 

背景：喉癌与下咽癌病情复杂，手术切除范围因此受限。本研究旨在探讨喉部及下咽部手术中切除边缘的临床意义。方法：对因喉鳞状细胞癌（LSCC）或下咽鳞状细胞癌（HSCC）接受全喉切除术（TL）或喉咽切除术（TLP）的患者进行回顾性队列研究。在原发性LSCC、复发性LSCC、原发性HSCC和复发性HSCC各组中，根据皇家病理学会标准，研究切除边缘状态与复发率及生存率之间的关系。结果：原发性LSCC的阳性切除边缘率为54%，复发性LSCC为29%，原发性HSCC为62%，复发性HSCC为44%。对于原发性和复发性LSCC，总复发率与边缘狭窄呈线性相关（p=0.007，p=0.008）。原发性和复发性LSCC的多变量生存分析显示，与边缘清晰相比，边缘阳性患者的无病生存期和疾病特异性生存期显著更差。结论：原发性和复发性LSCC中，边缘接近与边缘清晰的生存率相似。这可能表明，在生存方面，>5毫米的边缘在临床上并不相关。因此，在某些部位应接受1-5毫米的边缘。边缘<1毫米与显著更差的预后相关，应予以避免。

原文链接：

Clinical Relevance of Resection Margins in Patients with Total Laryngectomy or Laryngopharyngectomy