既往气管切开患者行全喉切除术的病理T分期：一项回顾性研究。
Pathological T-staging in patients undergoing total laryngectomy with prior tracheostomy: A retrospective study.
文献信息
| PMID | 42826527 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Thomas Peter Maahs |
| 作者单位 | Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Hospital São Lucas, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Porto Alegre, RS, Brazil; Universidade Estadual de Campinas (UNICAMP), Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Campinas, SP, Brazil. Electronic address: Thomasmaahs@gmail.com. |
| 期刊 | Brazilian journal of otorhinolaryngology |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 2018年美国癌症联合委员会（AJCC）喉癌分类基于解剖侵犯定义分期，但未正式纳入既往气管切开。临床分期（cT）与病理分期（pT）之间的差异常使治疗决策复杂化。本研究旨在确定既往气管切开的临床必要性是否可作为接受初次全喉切除术患者pT4a分期的独立术前预测因素，从而辅助临床规划。
方法： 本回顾性研究审查了20年间因晚期喉鳞状细胞癌接受手术治疗患者的组织病理学记录。纳入标准要求术前临床分期提示广泛病变、需行全喉切除术，且无既往放化疗或喉部分手术史。提取了病理分期、淋巴结受累及微观特征数据。采用Fisher精确检验评估相关性，并通过多因素logistic回归计算效应量，得出比值比（OR）。
结果： 最终队列包括96例患者（93.75%为男性；中位年龄65岁）。39.6%的队列需要既往气管切开。pT4a分期与既往气管切开之间存在统计学显著关联，86.8%的气管切开患者最终病理显示pT4a病变（p = 0.013）。多因素logistic回归证实，晚期病理分期（T4a）是需要既往气管切开的唯一独立预测因素（OR = 4.41，95% CI；p = 0.010）。其他变量，包括淋巴结分期、组织学分级、神经周围侵犯和血管淋巴管侵犯，与既往气管切开的需求无显著独立关联。
结论： 在确定性全喉切除术之前临床需要气管切开是pT4a分期的强有力独立预测因素。在临床影像学不明确的情况下，既往气管切开可作为广泛解剖损害的替代标志物，为多学科肿瘤委员会支持首选手术切除的决策提供关键辅助数据。
英文摘要
OBJECTIVE: The 2018 American Joint Committee on Cancer (AJCC) classification for laryngeal cancer defines staging based on anatomical invasion but does not formally incorporate prior tracheostomy. Discrepancies between clinical staging (cT) and pathological staging (pT) often complicate therapeutic decision-making. The objective of this study was to determine if the clinical necessity of a prior tracheostomy serves as an independent preoperative predictor of pT4a staging in patients undergoing primary total laryngectomy, thereby assisting in clinical planning.
METHODS: This retrospective study reviewed the histopathological records of patients surgically treated for advanced laryngeal squamous cell carcinoma over a 20-year period. Eligibility criteria required a preoperative clinical staging indicative of extensive disease justifying total laryngectomy, without the presence of prior chemoradiotherapy or partial laryngeal surgeries. Data regarding pathological staging, nodal involvement, and microscopic characteristics were extracted. Associations were assessed using Fisher's Exact Test, and the magnitude of effect was calculated using multivariate logistic regression, yielding an Odds Ratio (OR).
RESULTS: The final cohort comprised 96-patients (93.75% male; median age 65-years). A prior tracheostomy was required in 39.6% of the cohort. A statistically significant association was established between pT4a staging and prior tracheostomy, with 86.8% of tracheostomized patients revealing pT4a disease on final pathology (p = 0.013). Multivariate logistic regression confirmed that advanced pathological staging (T4a) was the sole independent predictor of the need for prior tracheostomy (OR = 4.41, 95% CI; p = 0.010). Other variables, including nodal staging, histological grade, perineural invasion, and angiolymphatic invasion, did not show significant independent associations with the requirement for prior tracheostomy.
CONCLUSION: The clinical requirement of a tracheostomy prior to definitive total laryngectomy is a robust, independent predictor of pT4a staging. In the context of ambiguous clinical imaging, prior tracheostomy serves as a surrogate marker for extensive anatomical compromise, providing critical adjunctive data to support multidisciplinary tumor boards in decisions favoring primary surgical resection.