Functional organ preservation in larynx cancer: Correlation with baseline clinical and pathological features.

Abstract

e16037 Background: Functional organ preservation in larynx cancer has become a treatment quality aim. The goal of our study was to evaluate the potential association between clinical and pathological features and functional larynx preservation (FLP). Methods: Clinical and pathological features were registered from 43 consecutive patients who were diagnosed of squamous cell larynx cancer between Feb 2008 and Sep 2011 and were candidates to organ preservation approaches: surgery (1), radiotherapy (10), chemo/bioradiotherapy (26) or chemo/bioradiotherapy following induction chemotherapy (6). Kaplan Meier procedure was used to estimate FLP and OS. Log-rank test and Cox proportional hazards regression were performed to assess prognostic factors for FLP. Results: Median age was 62 years (23% >70 years). Former smokers 28% and alcohol consumers 70%. Most of the tumors were supraglottic (63% supraglottic/35% glottic/2% subglottic), T3 (T4 9%/T3 67%/T2 19%/T1 5%), N0 (N0 74%/N+ 26%), well/moderated differentiated histologic grade (HG) (I 23%/II 49%/III 14%) and stage III or IV (I 2%/II 16%/III 58%/IVA 23%). 33% required pretreatment tracheostomy. At the time of the analysis, with a median follow-up of 21 months, 7(16%) deaths and 18(42%) recurrences had occurred. The cumulative proportion of patients with larynx preservation at 2 years was 48%, and the median FLP survival was 21 months (CI 95%: 10.5-31.5). The most common cause of FLP failure was recurrence, that required salvage laryngectomy in 77% of cases. The following features were found to have a significant negative impact on FLP: T4 (HR: 9.04), former smoker (HR: 2.45), N+ (HR 1.36) and stage IV (HR: 2.44). Other factors such as tumor location, age, alcohol consumption, HG and pretreatment tracheostomy were not significant. Conclusions: The most relevant risk factors for FLP in our analysis were T4 stage, lymph node status, former smoker status and stage IVA. Therefore, patients presenting these features would not be optimal candidates for organ preservation approaches. Correlation of these prognostic factors with predictive biomarkers for specific treatments is warranted.