Histopathological factors influencing results of combined treatment in patients with laryngeal cancer.

Abstract

The aim of the study was to assess the prognostic value of postoperative histopathological factors as well as the clinical usefulness of the modified risk score for recurrence. In a group of 197 patients with laryngeal cancer who underwent surgery followed by radiation therapy, partial resection was performed in 21.5% of patients and total resection in 78.5%. The majority of patients had T3 or T4 (74%) and N0 (63%) cancer. Macroscopically positive margins were reported in 10% of patients after partial resection and in 7% of patients after total resection, whereas microscopically positive margins were observed in 31% and 20% of cases, respectively. Extracapsular extension was observed in 22% of patients. In order to estimate local and nodal recurrence risk rates, criteria developed by Peters were used. Five-year local control (LC) was achieved in 88% of patients, disease-free survival (DFS) in 68% of patients and overall survival (OS) in 73% of patients. In the case of macroscopically positive margins, the 5-year DFS was 33% lower compared to radical surgery and 25% lower in the case of microscopically positive margins. The 5-year DFS was reduced by 29% due to extracapsular extension. Cox model analysis indicated that the degree of recurrence risk was the most potent independent prognostic factor for postoperative radiation therapy in laryngeal cancer. Negative histopathological factors influencing results of combined treatment of laryngeal cancer include macro- and microscopically positive margins, neck lymph node involvement and extracapsular extension.