Background: Laryngeal cancer affects quality of life (QoL), speech, and swallowing. Total laryngectomy (TL) causes severe impairments, while partial laryngectomy (PL) and chemoradiotherapy (CRT) preserve the organ but yield variable outcomes. This study assesses QoL, speech rehabilitation, swallowing, and social reintegration across these treatments. Methods: This prospective observational cohort study was conducted at the ENT Clinic, Victor Babeș University of Medicine and Pharmacy, Timișoara; recruitment was conducted between October 2019 and January 2024. Seventy-five patients diagnosed with laryngeal squamous cell carcinoma (LSCC) were initially enrolled but only 15 patients (20%) completed the 12-month follow-up, with an attrition rate of 80%. Tumor stages ranged from T1 to T4a, with TL patients having a higher proportion of advanced-stage disease (Stage III–IV: 76%) compared to PL (45%) and CRT (50%). Validated instruments, including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Head and Neck Cancer (EORTC QLQ-H&N35), the Voice Handicap Index-30 (VHI-30), the Hospital Anxiety and Depression Scale (HADS), and the Dysphagia Outcome and Severity Scale (DOSS), were used to assess QoL, voice function, swallowing function, and psychological impact. Results: At 12 months, the global QoL score from the EORTC QLQ-H&N35 was lowest in TL patients (49.8 ± 10.9), significantly lower than both PL (61.2 ± 9.6,p= 0.002) and CRT (64.1 ± 7.8,p< 0.001). Post hoc Bonferroni analysis confirmed significant pairwise differences between TL vs. PL (p= 0.002) and TL vs. CRT (p< 0.001), while the difference between PL and CRT was non-significant (p= 0.14). TL patients had higher speech-related disability (VHI: 88.3 ± 12.6) and dysphagia prevalence (DOSS: 4.0 ± 1.2), with 16% remaining enteral feeding-dependent. Anxiety (HADS-A: 7.5 ± 2.9) and depression (HADS-D: 9.0 ± 3.2) were highest in TL patients, with 36% meeting clinical depression criteria at 12 months. Multivariable regression identified TL (OR = 3.92, 95% CI: 2.14–5.79,p< 0.001) and advanced tumor stage (OR = 2.85, 95% CI: 1.79–4.21,p= 0.002) as strong predictors of poor QoL. Kaplan–Meier analysis showed no significant OS differences (p= 0.12), but CRT patients had lower DFS (78%) compared to TL (82%) and PL (85%) (p= 0.048). Conclusions: TL patients experience the most significant impairments in QoL, speech, and social reintegration despite rehabilitation. CRT patients show higher recurrence rates but better QoL, while PL offers the best balance of function and survival. These findings highlight the need for long-term survivorship support tailored to treatment type.
背景：喉癌影响患者生活质量、言语及吞咽功能。全喉切除术导致严重功能障碍，而部分喉切除术与放化疗虽能保留器官但疗效各异。本研究旨在评估不同治疗方案对生活质量、言语康复、吞咽功能及社会再融入的影响。 方法：本前瞻性观察队列研究在蒂米什瓦拉维克托·巴贝什医药大学耳鼻喉科开展，于2019年10月至2024年1月期间招募患者。初始纳入75例喉鳞状细胞癌患者，仅15例（20%）完成12个月随访，失访率达80%。肿瘤分期涵盖T1至T4a期，全喉切除组晚期患者比例（III–IV期：76%）高于部分喉切除组（45%）和放化疗组（50%）。采用欧洲癌症研究与治疗组织头颈癌生活质量问卷、嗓音障碍指数量表-30、医院焦虑抑郁量表及吞咽功能结局与严重程度量表等标准化工具评估生活质量、嗓音功能、吞咽功能及心理影响。 结果：12个月时，全喉切除组整体生活质量评分最低（49.8±10.9），显著低于部分喉切除组（61.2±9.6，p=0.002）和放化疗组（64.1±7.8，p<0.001）。Bonferroni事后检验证实全喉切除组与部分喉切除组（p=0.002）、全喉切除组与放化疗组（p<0.001）存在显著差异，而部分喉切除组与放化疗组间无统计学差异（p=0.14）。全喉切除组患者言语功能障碍更严重（嗓音障碍指数：88.3±12.6），吞咽困难发生率更高（吞咽功能评分：4.0±1.2），16%患者仍需肠内营养支持。该组焦虑（7.5±2.9）与抑郁（9.0±3.2）评分最高，36%患者在12个月时达到临床抑郁标准。多变量回归分析显示全喉切除术（OR=3.92，95%CI：2.14–5.79，p<0.001）和晚期肿瘤分期（OR=2.85，95%CI：1.79–4.21，p=0.002）是生活质量下降的强预测因子。Kaplan-Meier分析显示总生存期无显著差异（p=0.12），但放化疗组无病生存率（78%）低于全喉切除组（82%）和部分喉切除组（85%）（p=0.048）。 结论：尽管接受康复治疗，全喉切除患者仍在生活质量、言语功能及社会再融入方面面临最显著障碍。放化疗患者虽复发率较高但生活质量更优，而部分喉切除术在功能保留与生存获益间达到最佳平衡。这些发现凸显了根据治疗类型制定长期生存支持方案的必要性。
Long-Term Quality of Life and Functional Outcomes in Patients with Total Laryngectomy
肿瘤(癌症)患者之家