[Transoral laser microsurgery for T1b glottic carcinoma: analysis of therapeutic outcomes and prognostic study of anterior commissure staging].

Abstract

Objective: To analyze the oncological outcomes of transoral laser microsurgery (TLM) for T1b glottic carcinoma and to investigate the impact of anterior commissure (AC) involvement on prognosis. Methods: This retrospective case series study included 107 patients with T1b glottic carcinoma who underwent TLM at the Department of Otorhinolaryngology, Second Affiliated Hospital of Zhejiang University School of Medicine, from January 1, 2012, to June 30, 2024. The cohort comprised 101 males and 6 females, aged from 43 to 85 years (median age, 64 years), with a follow-up duration of 12.0 to 146.6 months (median follow-up, 34.6 months). Patients were stratified by AC involvement grade (AC0-3: 19, 24, 39, and 25 cases, respectively). The primary endpoints were the 3-year and 5-year local control rate (LCR) and disease-specific survival (DSS). Statistical analysis was performed using SPSS software (version 25.0). Results: Among the 107 patients, the overall 3 year and 5 year LCR were 93.1% and 86.6%, respectively; the corresponding DSS rates were 99.1% and 95.7%. Tumor recurrence occurred in 9 patients, showing an increasing trend with higher AC grades. The 5 year LCR for AC0, AC1, AC2, and AC3 was 94.4%, 95.7%, 87.3%, and 61.3%, respectively. Of the 9 recurrent patients, 7 underwent re-TLM, and 2 died of the disease. No severe complications occurred. Anterior commissure thickness was significantly correlated with tumor recurrence (t=-2.181, P=0.032). Postoperative complications included vocal cord leukoplakia (n=7), vocal cord adhesion (n=6), and persistent granulation tissue (n=4), all managed with secondary surgery. Staged surgery was performed in 10 patients, and ventricular band mucosal flaps were applied in 15 patients. Conclusion: TLM demonstrates favorable oncological efficacy in the treatment of T1b glottic carcinoma. TLM should be used with caution in patients with severe AC involvement. Although LCR tends to decrease with higher AC grades, this trend lacks statistical significance, and the conclusion awaits further validation.