Voice And Survival Analysis Of Patients With T1 Glottis Squamous Cell Carcinoma Treated With Radiofrequency Ablation Or Radiotherapy

Objective:To investigate the reliability and validity of the acoustic voice quality index(AVQI)in Mandarin Chinese.Methods:50 participants with normal voice and 50 participants with various voice disorders were enrolled in this study.All participants did their larynx check using a stroboscope and two professional otolaryngologists to determine whether the larynx function was normal.They read aloud two sentences in Mandarin Chinese and the sustained the vowel/a:/;then filled the Voice Handicap Index(VHI-30)questionnaire.Two laryngologists evaluated the samples to determine the grade of dysphonia(G).The middle three seconds of vowel/a:/and the two sentences were analyzed using AVQI script version 02.03 in Praat(version 6.0).The Kappa coefficient was used to determine the consistency of the evaluators.The receiver operated characteristic(ROC)curve and Youden index were used to analyze the accuracy of the diagnosis,and Spearman’s correlation was to evaluate the correlation of AVQI values with other measurements.Results:Kappa coefficient analysis found a high degree of agreement between two otolaryngologists who judged the results of stroboscope and between two otolaryngologists who scored GRBAS.ROC curve analysis of AVQI value was carried out using the results of stroboscope as the gold standard,and the result was AUC=0.920,P<0.001.It indicates that AVQI value has good accuracy in the identification between normal and abnormal voice.The cutoff value of AVQI calculated by Youden index is 3.030,and the sensitivity is 85%and specificity is 93%respectively.Spearman correlation analysis showed that AVQI value was highly positively correlated with the results of stroboscope(rs=0.730;P<0.001)and a strong positive correlation with Gmean score(rs=0.751;P<0.001);while the correlation between AVQI and VHI-30 score was poor(rs=0.376;P<0.001).Conclusions:The validity and specificity of AVQI values have been confirmed in other languages,but not in Mandarin Chinese.This study confirmed AVQI could distinguish between normal voice and abnormal voice very well in Mandarin Chinese for the first time.It has a good correlation with stroboscope and GRBAS.Due to its simple operation,non-invasive and sensitive and accurate outcomes,AVQI value has the potential to be used as a measurement tool in parallel with stroboscope and GRBAS score in clinical practice.Background:The optimal treatment for early glottis carcinoma has always been controversial.The aim of this study of patients with T1 glottis squamous cell carcinoma was to compare the oncologic and voice outcomes after treatment with endoscopic surgery with radiofrequency ablation or radiotherapy,and to provide evidence for the treatment of T1 glottis squamous cell carcinoma.Patients and methods:Retrospective analysis was performed on 190 patients with T1 glottic laryngeal squamous cell carcinoma in the Department of Otolaryngology of Peking Union Medical College Hospital.Grouping was performed by case control matching of SPSS.71 patients treated by radiofrequency ablation and 71 patients treated by radiotherapy were matched for age,gender,tumor stage,smoking and drink history,margin and involvement of the anterior commissure.Three year,five year,ten year overall survival and disease free survival were analyzed by Log-rank test.Univariate analysis and multivariate evaluation were compared using the Cox proportional hazards model.Subjective voice results were evaluated using the Mandarin version of VHI-30 questionnaire,auditory perception was evaluated using GRBAS score,and objective acoustic analysis was analyzed using PAAT software(version 6.0)combined with voice quality index plug-in(version 02.03),and voice quality index was exploratively used as one of the evaluation parameters.The results were compared by Mann-Whitney U test.Results:Log-rank test showed that the 3-year,5-year and 10-year overall survival in radiofrequency ablation surgery group and radiotherapy group were 98.6%vs.93.0%,respectively;P=0.083,95.8%vs.87.3%;P=0.086,93.0%vs.87.3%;P=0.114.The 3-year,5-year,and 10-year disease-free survival of radiofrequency ablation surgery group and radiotherapy group were 93.0%vs.70.4%;P<0.001,90.0%vs.69.0%;P<0.001,87.3%vs.69.0%;P<0.001.The above results indicated that there was no significant difference in overall survival rate between the two groups,and the disease-free survival rate in the radiofrequency ablation surgery group was significantly better than that in the radiotherapy group.After multivariate analysis of Cox,the results showed the same trend as the Log-rank analysis.After stratified analysis according to T stage,the recurrence rates of 3,5 and 10 years in the T1a group were significantly lower in the RFA surgery group(P<0.05),and there was no significant difference between the two groups(P>0.05).In T1b group,the 3 years,5 years,10 years mortality and recurrence rates were no significant difference(P>0.05)between the two therapy groups.There was no statistically significant difference in VHI-30 scores between the radiofrequency ablation surgery group and the radiotherapy group in patients with T1a glottis cancer after 1 year DFS(P=0.54).In patients with T1b glottis cancer,VHI-30 scores in the radiotherapy group were significantly lower than those in the radiofrequency ablation surgery group(P<0.001).The objective voice assessment showed the same trend.Conclusion:Radiofrequency ablation surgery is safe and efficient for the treatment of patients with T1 GSCC,resulting in ideal overall survival and lower recurrence rate.RFA is more recommended than radiotherapy for patients with T1a glottis carcinoma.However,for patients with T1b glottic cancer,radiotherapy is the preferred option.