Clinical Analysis Of Local Recurrence And Reoperation Of Laryngeal Squamous Cell Carcinoma After Surgery

Objective: To analyze the related factors of local recurrence in patients with laryngeal squamous cell carcinoma after surgery,and to explore the therapeutic effect of local recurrence reoperation in patients with laryngeal squamous cell carcinoma after laryngeal function preservation surgery.Methods: The clinical data of laryngeal cancer patients who underwent surgical treatment from January 1,2002 to December 31,2015 in our hospital were analyzed retrospectively.A total of 14 selected clinical factors might cause recurrence were analyzed by Log rank test and Cox regression.1 year,3 year,5 year and 10 year cumulative overall survival rate and disease-free survival rate were analyzed by Kaplan-Meier Method.At the same time,the patients who had recurrence of laryngeal squamous cell carcinoma after the first operation of the conservation laryngeal surgery and re-surgery before December 31,2015 were selected from our Hospital.According to the reoperation methods,the patients with conservation laryngeal surgery or total laryngectomy were divided into two groups.The survival rate,recurrence and quality of life after reoperation were compared between the two groups.We used the SPSS 24.0 to analysis data,P < 0.05 was considered statistically significant.Results: A total of 476 patients were included in the analysis of the factors related to local recurrence of laryngeal squamous cell carcinoma after surgery.During follow-up,133 patients relapsed and 147 died.Kaplan-meier was used to calculate the survival rate.The overall survival rates at 1,3,5 and 10 years were 95.6%,79.9%,72.6% and 62.1%,respectively,and the disease-free survival rates at 1,3,5 and 10 years were 83.0%,70.4%,63.1% and 55.5%,respectively.Single-factor analysis by Log rank test revealed the P < 0.05 of smoking history,drinking history,T stage,N stage,clinical stage,cervical lymph node dissection,pathological grade,surgical margin and postoperative radiotherapy,suggesting these factors may affect the local recurrence of laryngeal squamous cell carcinoma.COX regression wasused for multivariate analysis,it is concluded that smoking history,T stage,pathologic stage,surgical margin and postoperative radiotherapy are the independent factors of laryngeal squamous carcinoma postoperative local recurrence.Among them,smoking history,T stage,pathological grade and margin of resection are the risk factors for local recurrence,while postoperative radiotherapy is the protective factor.In the efficacy analysis of the reoperation options in the patients with local recurrence after conservation laryngeal surgery,21 cases of partial laryngectomy and 32 cases of total laryngectomy were included.A total of 21 patients had recurrence of laryngeal squamous cell carcinoma during follow-up,and 22 patients died.Patients were divided into two groups according to the surgery methods of partial laryngectomy and total laryngectomy.Kaplan-meier method and Log rank test were used to compare OS and DFS between the two groups,revealing that no statistically significant difference in OS and DFS between the two groups for the P>0.05.Conclusions: The independent factors affecting postoperative local recurrence of laryngeal squamous cell carcinoma include smoking history,T staging,pathological grade,surgical margin and postoperative radiotherapy.Among them,smoking history,T stage,pathological grade and surgical margin are the risk factors,while postoperative radiotherapy is the protective factor.For laryngeal squamous cell carcinoma patients with local recurrence after partial laryngectomy,there was no significant difference in OS and DFS between partial laryngectomy and total laryngectomy.After comprehensive evaluation of tumor patients and strict control of their surgical indications,the selective implementation of salvage surgery to preserve the laryngeal function is feasible and can improve the quality of life of such patients.