Risk factors for local recurrence of early bilateral vocal cord carcinoma treated with transoral CO₂ laser microsurgery

Abstract

Background

The incidence of local recurrence after transoral CO₂ laser microsurgery for T1b–T2 glottic carcinoma is relatively low. Multiple risk factors have been described for the development of local recurrence after treatment. However, to date, there is no analysis or systematic review investigating the relationships between clinical and histopathological factors and the appearance of local recurrence after transoral CO₂ laser microsurgery in T1b–T2 glottic carcinoma patients.

Aims/objective

To investigate risk factors for local recurrence after CO₂ laser surgery in T1b–T2 glottic carcinoma involving bilateral vocal cords.

Material and methods

We retrospectively studied patients undergoing CO₂ laser surgery for T1b–T2 glottic carcinoma involving bilateral vocal cords. Multiple follow-up laryngoscopies and computed tomographies were performed. Main outcome measures: survival rate, local recurrence rate, and independent risk factors for recurrence.

Results

All 85 patients (83 male; age, 63.33 ± 10.59 years; 36 T1b and 49 T2 lesions; 28 cases with and 57 without anterior commissure (AC) involvement) survived; 15 exhibited postoperative local recurrence. Recurrence rates differed between the following groups: patients without (6/57) versus patients with AC involvement (9/28) (p = .007); patients with negative (11/77) versus positive resection margins (4/8) (p = .014); p53-negative (5/51) versus p53-positive patients (10/34) (p = .0132). AC involvement, positive resection margins, and p53 expression were independent risk factors for recurrence.

Conclusions

Patients with stage T1b and T2 glottic carcinoma with AC involvement, positive resection margins, and p53 expression should be followed up at shorter intervals.

Significance

This article provided valid clinical data for risk factors for local recurrence after CO₂ laser surgery for T1b–T2 glottic carcinoma involving bilateral vocal cords.

Chinese abstract

背景：T1b-T2 声门癌经口 CO2 激光显微手术后局部复发的发生率相对较低。已经描述了治疗后局部复发的多种风险因素。然而, 迄今为止, 对于临床和组织病理学因素与T1b-T2 声门癌患者经口 CO2 激光显微手术后局部复发的关系, 还没有分析研究或系统评价。

目的：探讨 T1b-T2 双侧声带声门癌 CO2 激光手术后局部复发的危险因素。

材料和方法：我们回顾性研究了接受 CO2 激光手术的T1b–T2双侧声带声门癌患者。多次随访喉镜检查和计算机断层扫描。主要结果指标：生存率、局部复发率和复发的独立危险因素。

结果：所有85例患者都存活了（83例男性；年龄63.33±10.59岁；36个T1b病变和49个T2病变；28例有受累前连合 (AC)而57 例则无； 15例术后局部复发。以下患者群的复发率有差异：没有受累前连合 (6/57) 的患者与有受累前连合的患者(9/28) (p ¼ .007)；阴性切缘的患者 (11/77) 与阳性切缘的患者(4/8) (p ¼ .014); p53 阴性患者 (5/51) 与 p53 阳性患者 (10/34) (p ¼ .0132)。受累前连合、切缘阳性和 p53 表达是复发的独立危险因素。

结论：伴 AC 受累、阳性切除边缘和 p53 表达的T1b 期和 T2 期声门癌患者的回访间隔应更短。

意义：本文为T1b-T2 双侧声带声门癌CO2激光手术后局部复发的危险因素提供了有效的临床数据。

Keywords:

• Larynx
• neoplasm
• surgery
• local recurrence
• p53
• positive resection margins

Disclosure statement

The authors report no conflict of interest.

Additional information

Funding

This work was supported by the Beijing Municipal Administration of Hospitals’ Ascent Plan [no DFL20180202]; the Beijing Municipal Science & Technology Commission [no Z141107002514003]; the Capital Health Research and Development of Special Fund [no 2018-2-2054]; and the National Key R&D Program of China [no 2020YFB1312805].