早期声门型喉癌支撑喉镜下喉显微CO2激光手术的复发特征及风险预测模型分析

Analysis of recurrence characteristics and risk prediction model for early glottic laryngeal cancer treated with CO2 laser microsurgery under suspension laryngoscope

摘要:

目的 探讨支撑喉镜下喉显微CO₂激光手术治疗早期声门型喉癌的预后及风险预测模型。方法 回顾性分析2017年1月—2024年12月于西安交通大学第二附属医院接受支撑喉镜显微手术治疗的 234例早期（T _1-2N₀M₀）声门型喉癌患者的临床资料，所有患者随访时间均≥1年。收集患者人口学特征、吸烟饮酒史、TNM分期、病理分化程度及肿瘤亚区侵犯情况，采用Cox比例风险模型分析复发的独立危险因素；其中以分层递进法构建模型，并依据赤池信息量准则（AIC）与C统计量筛选精简模型，采用ROC曲线评估其区分度，按最佳截断值划分低、中、高危 3个风险层级，以Kaplan-Meier法比较组间无复发生存差异。结果 本研究共纳入234例患者，其中 42例（ 17.95%）患者术后复发。单因素分析结果显示，复发与T分期、肿瘤侵犯喉室、声门下区域及前联合有关（ P<0.05）；多因素Cox回归分析结果显示，吸烟、肿瘤低分化、肿瘤侵犯喉室及前联合是术后复发的独立风险因素（P<0.05），肿瘤低分化（P=0.051）接近预设显著性阈值，构建纳入吸烟史、肿瘤低分化、肿瘤侵犯喉室及前联合的精简预测模型，其预测支撑喉镜显微手术术后喉癌复发的ROC曲线下面积（AUC）为0.799（95%CI:0.722~ 0.876）。结论 支撑喉镜显微手术是治疗早期声门型喉癌的有效方案，吸烟、肿瘤低分化、肿瘤侵犯喉室及前联合是术后复发的独立风险因素，基于上述4项高危因素构建的精简预测模型对早期声门型喉癌患者术后复发具有良好的预测价值。

Abstract:

Objective To explore the prognosis, recurrence characteristics and risk prediction model of early glottic laryngeal cancer treated with CO₂ laser microsurgery under suspension laryngoscope. Methods A retrospective analysis was conducted on 234 patients with early-stage (T_1-2N₀M₀) glottic laryngeal cancer who underwent CO₂ laser microsurgery under suspension laryngoscope at the Second Affiliated Hospital of Xi’an Jiaotong University between January 2017 and December 2024. All patients were followed up for at least one year. The demographic characteristics of patients, smoking and drinking history, TNM stage, pathological differentiation degree and tumor sub-region invasion status were collected. The Cox proportional hazards model was adopted to analyze the independent risk factors for recurrence. Among them, a hierarchical progressive method was used to construct the model, and the Akaike Information Criterion (AIC) and C-statistics were used to screen the simplified model. The receiver operating characteristic (ROC) curve was used to evaluate its discrimination ability, and the low, medium and high-risk levels were divided according to the optimal cut-off value. The Kaplan-Meier method was used to compare the differences in recurrence-free survival among groups. Results A total of 234 patients were included in this study, with 42 (17.95%) experiencing recurrence. Univariate analysis showed that recurrence was associated with T stage, tumor involvement of the laryngeal ventricle, subglottic region, and anterior commissure (P<0.05). Multivariate Cox regression analysis identified smoking, tumor involvement of the laryngeal ventricle, and anterior commissure as independent risk factors for postoperative recurrence (P<0.05). Poor tumor differentiation (P=0.051) approached the prespecified significance threshold. A simplified predictive model incorporating smoking history, low tumor differentiation, and tumor involvement of the glottic vestibule and anterior commissure yielded an area under the curve (AUC) of 0.799 (95%CI: 0.722~0.876) for predicting laryngeal cancer recurrence after CO₂ laser microsurgery under suspension laryngoscope. Conclusions CO₂ laser microsurgery under suspension laryngoscope is an effective treatment for early glottic laryngeal cancer. Smoking, low tumor differentiation, involvement of the glottic vestibule, and anterior commissure invasion are independent risk factors for postoperative recurrence. A simplified predictive model based on these four high-risk factors demonstrates good value in predicting postoperative recurrence in patients with early glottic laryngeal cancer.