Oncological and vocal outcomes of patients with stage T1 glottis
squamous cell carcinoma: open surgery vs. radiofrequency ablation
Abstract
Objectives: The optimal treatment for stage T1 glottis squamous cell
carcinoma remains controversial. We compared the oncological and vocal
outcomes of patients who received endoscopic surgery with radiofrequency
ablation (RFA) or open surgery. Design&Setting&Participants: Data were
retrospectively collected for 93 patients who received primary treatment
by RFA (n = 65) or open surgery (n = 28) from 2008 to 2014. Main outcome
measures:Their characteristics were compared using the chi-square test.
The 5-year disease-free survival (DFS) and overall survival (OS) were
analyzed using the Kaplan-Meier method. Prognostic factors were assessed
by univariate analysis using the log-rank test and by multivariate
analysis using Cox models. Subjective vocal outcomes were evaluated by
Voice Handicap Index-30 (VHI-30) questionnaire. The VHI scores of the
two groups were compared using Mann-Whitney U test. Results and
Conclusions:The 5-year DFS was 72.3%(47 / 65) for the RFA group and
92.9% (26 / 28) for open surgery group The open surgery group and a
significantly better 5-year DFS (P=0.03), but the two groups had
comparable OS (RFA: 86.2%; open surgery: 78.6%; P=0.26). Open surgery
led to significantly worse voice quality (P<0.001). Among
patients who received open surgery, those with involvement of the
anterior commissure had higher total VHI scores (P=0.02).RFA and open
surgery were both effective surgical treatments for stage T1 glottis
squamous cell cancer. Open surgery was associated with a lower local
recurrence rate but a worse VHI score. Among patients receiving open
surgery, those with tumors involving the anterior commissure had poorer
vocal outcomes.