部分喉切除术与全喉切除术后的生活质量轨迹：按嗓音康复成功情况分层

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中文摘要

背景： 尽管部分喉切除术（PL）常因功能保留而被优先选择，但全喉切除术（TL）后的长期生活质量（QoL）结局可能因嗓音康复成功情况而有所不同。我们比较了PL、嗓音康复成功的TL（TL-S）和康复失败的TL（TL-F）患者五年纵向QoL轨迹。
方法： 92例患者被分为PL组（n=52）、TL-S组（n=21）和TL-F组（n=19）。使用欧洲癌症研究与治疗组织生活质量问卷核心30（EORTC QLQ-C30）和头颈癌特异性模块（EORTC QLQ-H&N35），在多个时间点（术前、1个月、3个月、1年、2年和5年）评估从基线至术后5年的QoL。在多个功能和症状领域评估纵向模式。使用广义估计方程分析组内纵向变化，并使用Kruskal-Wallis检验在每个时间点进行补充性组间比较。
结果： 到5年时，TL-S组的汇总评分与PL组相当，而PL组的总体健康状况/QoL仍更高。TL-S组在5年时也显示出更有利的言语评分，吞咽结局在较晚时间点接近PL组。相比之下，TL-F组显示出持续更高的吞咽相关负担，更广泛的症状负担，包括社交接触问题和财务困难，随时间推移仍更为明显。
结论： 嗓音康复状态可能与喉癌手术后的长期QoL模式相关。TL后成功康复可能与更有利的长期QoL模式相关，在选定领域的结局接近PL组，而康复不成功可能与持续较差的结局相关。

英文摘要

BACKGROUND: Although partial laryngectomy (PL) is often preferred for functional preservation, long-term quality-of-life (QoL) outcomes after total laryngectomy (TL) may vary according to voice rehabilitation success. We compared five-year longitudinal QoL trajectories among PL, TL with successful voice rehabilitation (TL-S), and TL with failed rehabilitation (TL-F).
METHODS: Ninety-two patients were categorized into PL (n = 52), TL-S (n = 21), and TL-F (n = 19). QoL was assessed from baseline to 5 years postoperatively using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and Head and Neck Cancer-Specific Module (EORTC QLQ-H&N35) at multiple intervals (pre-op, 1 month, 3 months, 1 year, 2 years, and 5 years). Longitudinal patterns were evaluated across multiple functional and symptom domains. Longitudinal within-group changes were analyzed using generalized estimating equations, and supplementary between-group comparisons at each time point were performed using the Kruskal-Wallis test.
RESULTS: By 5 years, the TL-S group showed a Summary Score comparable to that of the PL group, whereas global health status/QoL remained higher in the PL group. The TL-S group also showed more favorable Speech scores at 5 years, with swallowing outcomes approaching those of the PL group at later time points. In contrast, the TL-F group showed persistently higher swallowing-related burden, with broader symptom burden, including Social Contact problems and Financial Difficulties, remaining more pronounced over time.
CONCLUSIONS: Voice rehabilitation status may be associated with long-term QoL patterns after laryngeal cancer surgery. Successful rehabilitation after TL may be associated with more favorable long-term QoL patterns, with outcomes in selected domains approaching those of the PL group, whereas unsuccessful rehabilitation may be associated with persistently poorer outcomes.