| Background and purpose Due to laryngeal carcinoma’s malignance and poorprognosis,the treament of advanced cases (stage III and IV) has always been a challengefor most head and neck cancer surgeons. This paper mainly discuss the valuable factorsthat may interfere the effectiveness of various therapies, analyze the possibilities thatmay affect the survival and prognosis of patients with advanced laryngeal carcinoma,and explor possible methods to improve outcome for advanced laryngeal cancer patients,by analyzing data obtained from a restrospective analysis of53cases of advancedlaryngeal carcinoma.Methods A retrospective analysis which draw subject patients from2002January to2010April53patients with advanced laryngeal cancer who received initial treatment inthe First Affiliated Hospital of Dalian Medical University was performed. Among the29cases of phase III and24cases of phase IV,32cases of whom received partiallaryngectomy, and21cases received total laryngectomy.41of total53cases receivedaccelerator radiotherapy after surgery. All patients were followed up for a period ofmore than36months,4cases lost during follow-up, follow-up rate was92.5%.Thestatistic analysis was carried out by SPSS17.0for Windows, Kaplan-Meier isapplicated to perform survival analysis, the Cox regression model was used to analysisthe Influence factors for the prognosis of patients.Results The3-and5-year total overall survival rates of this group were66%and56%,with the median survival time was112months.3-and5-year overall survival rates were62%and57%in stage III,and68%and55%in stage IV.3-and5-year overall survivalrates for patients with partial laryngectomy were67%and57%, and61%and55%forpatients with total laryngectomy. the survival rate of patients after partial laryngectomyis slightly higher than that of patients with total laryngectomy, but no statisticallysignificant differences between the two overall survival rate(P＞0.05). The overallrecurrence rate of53cases of patients with advanced laryngeal cancer was45.3% (24/53). Among of which, there were13cases of the primary tumor recurrence,9casesof neck recurrence,2cases of distant metastasis (pulmonary metastasis);23cases ofsupraglottic carcinoma reoccurred in11cases,21cases with glottic carcinomareoccurred in8cases,2cases of4cases with subglottic carcinoma reoccurred,3casesof recurrence emerged from5cases with across the glottic cancer;32cases who undergopartial laryngectomy recurred in15cases,21cases of total laryngectomy recurred in9cases.The total mortality was37.7%(20/53), including9cases of death due to primaryrecurrence,8cases died of cervical recurrence,2cases of distant metastasis death,1cases of unexplained death. Cox regression multi-factor analysis showed factors such asgender,age,cervical lymph node metastasis, methods of the primary surgical procedureand Postoperative radiotherapy(P<0.05) may affect the prognosis of adcanced laryngealcarcinoma.Conclusions The prognosis of advanced laryngeal carcinomais is poor,the3-and5-year overall survival of this group is similar with the domestic literature’sreport.Surgical operation is still the main treatment method for advanced laryngealcarcinoma,when selecting surgical procedures as the method of choose to preservelaryngeal function, we should strictly enforce the operation indications, accompany witha close follow-up. when local recurrence was confirmed, an urgent salvagelaryngectomy is extremely necessary; Cervical lymph node recurrence is one of themain reasons for the failure of advanced laryngeal cancer treatment and the leadingcause of death, therefore, treatment of cervical lymph nodes is crucial.Gender,age,cervical lymph node metastasis,the primary operation and Postoperativeradiotherapy are the factors affected the prognosis of advanced laryngeal carcinoma. |
PDF Full Text Request