Long-term efficacy of transoral endoscopic plasma resection in the treatment of early glottic laryngeal cancer and analysis of prognostic factors

Abstract

This study aimed to evaluate the efficacy of transoral endoscopic plasma resection (TEPR) in treating early glottic laryngeal cancer (GLC) and identify prognostic factors. A retrospective analysis was conducted on the medical records of 212 patients with early GLC treated with TEPR between February 2015 and September 2018 at Dongying People's Hospital. Clinical characteristics, objective voice function changes, and clinical outcomes of the patients were analyzed. Meanwhile, Kaplan-Meier curve was plotted to assess the impact of TERP on 3- and 5-year survival in GLC patients. Additionally, univariate and multivariable logistic regression analyses were performed to assess prognostic factors for GLC recurrence, and Receiver Operating Characteristic (ROC) curves were generated to assess their predictive value for patients' prognosis. After surgery, Patients' Jitter (%), Shimmer (%) showed significant improvement from pre-surgery, in contrast to Harmonic noise ratio and maximum phonation time, which underwent a significant decrease. The study assessed success and recurrence rates over 3- and 5-year follow-up periods, revealing a disease control rate of 86.79%, with 3- and 5-year recurrence rates of 14.62% and 20.28%, respectively. Patients were categorized into favorable and unfavorable prognosis groups based on the 3-year recurrence. Univariate analysis identified significant risk factors for recurrence, including age, tumor-node-metastasis (TNM) stage, clinical stage, and cumulative anterior commissure involvement (P < 0.05). Further multivariate logistic regression confirmed the above indexes as independent risk factors impacting patient prognosis. In conclusion, TEPR effectively treats early GLC, though recurrence risk persists, with age, TNM stage, clinical stage, and anterior commissure involvement identified as prognostic risk factors, suggesting the need for targeted preventive measures in clinical practice.

Keywords: Transoral endoscopic plasma resection; glottic laryngeal cancer; prognosis; risk factor.

Figure 1

Kaplan-Meier survival analysis. A: 3-year recurrence rate after operation; B: 5-year recurrence rate after operation.

Figure 2

ROC curves for predicting prognosis in glottic laryngeal cancer patients. A: ROC curve of age in predicting prognosis; B: ROC curve of TNM stage in predicting prognosis; C: ROC curve of clinical stage in predicting prognosis; D: ROC curve of cumulative anterior commissure in predicting prognosis. Note: ROC: Receiver Operating Characteristic.