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2021, vol. 50, br. 1-2, str. 7-11
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Analiza pojave, mesta i tretmana recidiva karcinoma larinksa
Analysis of the occurrence, location and treatment of laryngeal carcinoma recurrence
aUniverzitet u Prištini sa privremenim sedištem u Kosovskoj Mitrovici, Medicinski fakultet, Srbija bUniverzitet u Novom Sadu, Medicinski fakultet, Srbija cKliničko bolnički centar Kosovska Mitrovica, ORL odeljenje, Kosovska Miitrovica
e-adresa: jugogasic@gmail.com
Sažetak
Uvod: Efikasnost primenjenog modela lečenja laringealnog karcinoma meri se pojavom recidiva. Pojava recidiva značajno smanjuje preživljavanje i određuje tip naknadnog tretmana. Cilj: Utvrditi učestalost pojave recidiva karcinoma larinksa, mesto recidiviranja i definitivni tretman recidiva laringealnog karcinoma u odnosu na primenjene različite tipove hirurškog lečenja. Rezultati: Analizirano je 844 ispitanika sa primarno operisanim planocelularnim laringealnim karcinomom u periodu od 2002. godine do 2017. godine. Recidiv se razvio kod 191/844 (22.6%) ispitanika. Prosečno vreme do rezvoja recidiva iznosi 12.6 me-seci. Supraglotisni karcinom češće daju recidive u odnosu na glotisne 35.93%/17.46%, p=0.000. Kod N0 vrata pojava recidiva je u 14.42% a kod N+ vrata u 45.91, p=0.000. Sa porastom stadijuma bolesti raste i broj recidiva, p=0.000. Najčešće mesto recidiviranja je vrat sa 45%, zatim lokalni recidiv sa 25.1%. Recidiv se najčešće javlja kod ispitanika sa načinjenom totalnom laringektomijom i parcijalnim faringektomijom 50%. Najučestaliji razvoj regionalnog recidiva je kod N3 kategorije i ekstra-kapsularnog širenja, 72.7%. Definitivni tretman recidiva najčešće podrazumeva radikalnu disekciju vrata, i totalnu laringe-ktomiju. Ispitanici sa pojavom recidiva imaju značajno niže trogodišnje ukupno preživljavanje u odnosu na one bez pojave recidiva 47.6%/92.3%, p=0.000. Zaključak: Pojava recidiva je očekivana kod svakog četvrtog bolesnika u prvih 36 meseci nakon primenjenog bilo kog tipa hirurškog tretmana karicinoma larinksa. Efikasnost lečenja je u direktnoj vezi sa pojavom recidiva. Recidivi se češće javljaju kod viših stadijuma bolesti, ekstrakapsularnog širenja i prisutnih metastaza na vratu. Recidivi značajno smanjuju ukupno preživljavanje bolesnika sa laringealnim karcinomom.
Abstract
Introduction: The efficacy of the applied model of laryngeal cancer treatment is measured by recurrence. Recurrence significantly reduces survival and determines the type of subsequent treatment. Objective: To determine the incidence of laryngeal cancer recurrence, the location of recurrence, and the definitive treatment of laryngeal cancer recurrence concerning different types of surgical treatments applied. Results: In the period from 2002 to 2017, 844 subjects with primary operated laryngeal squamous cell carcinoma were analyzed. Recurrence developed in 191/844 (22.6%) subjects. The mean recurrence time is 12.6 months. Supraglottic carcinoma is more likely to recur than glottic carcinoma 35.93% / 17.46%, p = 0.000. In N0 necks the recurrence rate is 14.42% and in N + necks it is 45.91, p = 0.000. In more advanced stages of the disease, the number of recurrence increases, p = 0.000. The most common area of recurrence is the neck with 45%, followed by local recurrence with 25.1%. Recurrence most often occurs in subjects with total laryngectomy and partial pharyngectomy, 50%. The most common development of regional recurrence is in the N3 category and extracapsular spread, 72.7%. The definitive treatment of recurrence usually involves radical neck dissection and total laryngectomy. Subjects with recurrence have a significantly lower three-year overall survival compared to those without recurrence, 47.6% / 92.3%, p = 0.000. Conclusion: Recurrence is expected in every fourth patient in the first 36 months following any type of surgical treatment of laryngeal carcinoma. The efficacy of treatment is directly related to recurrence. Recurrence is more common in more advanced stages of disease, extracapsular spread, and present metastases in the neck. Recurrence significantly reduces the overall survival of patients with laryngeal cancer.
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