Objective: To investigate the prognosis and influencing factors of endoscopic surgery for early glottic carcinoma. Methods: In this retrospective study, we applied the Cox proportional hazards regression model and the random survival forest model to analyze the clinical characteristics of 385 patients [362 males, 23 females, age ranging from 33 to 91 years (62.0±9.6)] who visited the Sixth Medical Center of the General Hospital of the People's Liberation Army from January 2009, to December 2022 and diagnosed with early glottic carcinoma, encompassing variables such as age, gender, T stage, surgical approach, pathological typing, etc. The primary evaluation indicators were overall survival(OS) and disease-free survival rates (DFS). The follow-up duration ranged from 30 to 5,557 days (with a median follow-up time of 1,596 days). Results: After a three-year follow-up, the OS rate for the 385 patients was 95.83%, while the DSF rate was 82.98%. The Cox proportional hazards regression analysis revealed age (HR=2.35, 95%CI: 1.75 to 3.15, P<0.001) and T staging (HR=1.59, 95%CI: 1.13 to 2.23, P=0.019) as predominant factors affecting the OS and DFS. The random survival forest model identified poor tumor differentiation, and high expression of P53 and Ki-67 as predictors of inferior prognosis. Conclusion: Endoscopic surgery for early glottic carcinoma yields favorable short-term OS and reduces short-term recurrence rates, with T-stage emerging as a pivotal factor influencing recurrence. Tumors with poor differentiation and elevated expression of P53 may be indicative of an increased risk of recurrence.
目的： 探讨早期声门型喉癌内镜手术的预后及影响因素。 方法： 该回顾性研究采用Cox比例风险回归模型和随机生存森林模型对2009年1月至2022年12月就诊于解放军总医院第六医学中心的早期声门型喉癌385例患者［男362例，女23例，年龄33~91（62.0±9.6）岁］的临床特点（包括年龄、性别、T分期、手术方式、病理分型等）进行分析，主要评价指标为总生存率和无病生存率。随访时长为30~5 557 d（中位随访时间为1 596 d）。 结果： 385例患者在接受治疗后3年的总生存率为95.83%；同时，其对应的无病生存率为82.98%。Cox比例风险回归模型分析表明，年龄（风险比=2.35，95%置信区间：1.75~3.15， P<0.001）和T分期（风险比=1.59，95%置信区间：1.13~2.23， P=0.019）是影响患者总生存率和无病生存率的主要因素。随机生存森林模型显示，肿瘤的分化程度、P53和Ki-67的高表达与较差的预后相关。 结论： 早期声门型喉癌通过根治性手术能够取得较好的短期生存率和较低的短期复发率。T分期是影响复发率的主要因素。肿瘤的低分化状态与P53的高表达水平，可能预示着较高的复发风险。.