年轻喉鳞状细胞癌患者全喉切除术后的生存与复发模式
Survival and Recurrence Patterns After Total Laryngectomy in Young Laryngeal Squamous Cell Carcinoma Patients.
文献信息
| PMID | 42840668 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Clara D Si |
| 作者单位 | Vanderbilt University School of Medicine Vanderbilt University Medical Center Nashville Tennessee USA. |
| 期刊 | OTO open |
| SCI 分区 | Q2 |
| IF | 1.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
目的： 年龄在喉鳞状细胞癌（LSCC）中的预后作用仍不明确，尤其是全喉切除术（TL）后的复发方面。本研究评估了年龄对TL后LSCC结局的影响。
研究设计： 回顾性单机构队列研究。
地点： 学术性三级医疗中心。
方法： 我们回顾了1999年至2024年间接受TL的LSCC患者，按手术时年龄分组：<45岁与≥45岁。使用Kaplan-Meier法和log-rank检验评估总生存期（OS）和无病生存期（DFS）。使用累积发生率函数和Gray检验分析部位特异性复发。使用Fine-Gray模型的多变量竞争风险回归评估年龄与复发的关联。
结果： 在646例TL患者中，17例<45岁。<45岁组的5年OS为82.0%，≥45岁组为54.3%（P = .023）；5年DFS分别为70.2%与42.9%（P = .023）。两年龄组之间总体复发无显著差异。竞争风险分析显示，局部、区域或远处复发的累积发生率无显著差异。在调整T分期、N分期、喉切除术指征和辅助治疗的多变量分析中，较年轻年龄与复发无独立关联（sHR 0.55，95% CI 0.18-1.63，P = .28）。
结论： 较年轻的LSCC TL患者尽管复发风险相当，但表现出更好的OS和DFS。年龄与复发无独立关联，提示年轻患者生存改善并不反映肿瘤控制方面的差异。这些发现强调了区分生存与复发结局的重要性，并强调需要更大规模的研究来评估年轻患者的生存差异。
英文摘要
OBJECTIVE: The prognostic role of age in laryngeal squamous cell carcinoma (LSCC) remains unclear, particularly regarding recurrence after total laryngectomy (TL). This study evaluated the impact of age on LSCC outcomes following TL.
STUDY DESIGN: Retrospective single-institution cohort study.
SETTING: Academic tertiary medical center.
METHODS: We reviewed LSCC patients who underwent TL between 1999 and 2024 grouped by age at surgery: <45 versus ≥45 years. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier and log-rank tests. Site-specific recurrence was analyzed using cumulative incidence functions with Gray's test. Multivariable competing risk regressions with the Fine-Gray model evaluated the association of age with recurrence.
RESULTS: Among 646 TL patients, 17 were <45 years. Five-year OS was 82.0% for <45 versus 54.3% for ≥45 (P = .023); 5-year DFS was 70.2% versus 42.9% (P = .023). There was no significant difference in overall recurrence between age groups. Competing risk analysis showed no significant difference in cumulative incidence of local, regional, or distant recurrence. In multivariable analysis adjusting for T stage, N stage, laryngectomy indication, and adjuvant therapy, younger age was not independently associated with recurrence (sHR 0.55, 95% CI 0.18-1.63, P = .28).
CONCLUSIONS: Younger LSCC TL patients demonstrated improved OS and DFS despite comparable recurrence risk. Age was not independently associated with recurrence, suggesting that improved survival in younger patients does not reflect differences in oncologic control. These findings highlight the importance of distinguishing survival from recurrence outcomes and underscore the need for larger studies evaluating survival differences in younger patients.