Abstract
A picture is emerging in which advanced laryngeal cancers (LCs) are potentially not homogeneous and may be characterized by subpopulations which, if identified, could allow selection of patients amenable to organ preservation treatments in contrast to those to be treated with total laryngectomy (TL). This work aims to analyze a multicentric cohort of T3-T4a LCs treated by upfront TL, investigating the clinical and pathological features that can best predict oncologic outcomes. A total of 149 previously untreated patients who underwent TL for T3-T4a LC at four institutions were analyzed. Survival and disease-control were considered as the main outcomes. A secondary end-point was the identification of covariates associated with nodal status, investigating also the tumor thickness. T and N categories were significantly associated with both overall and disease-specific survival. The number of positive nodes and tracheal involvement were associated with loco-regional failure; post-cricoid area invasion and extra-nodal extension with distant failure. Posterior laryngeal compartment involvement was not a significant prognostic feature, by either univariable and multivariable analyses. These results support the conclusion that laryngeal compartmentalization has no impact on survival in patients treated by upfront TL and the current TNM staging system remains a robust prognosticator in advanced LC.
Highlights
Laryngeal cancer (LC), based on the Surveillance, Epidemiology, and End Results (SEER) database for the period 2009–2015, accounts for 0.7% of all new malignant tumors diagnosed in the UnitedStates each year
Rightly recommended total laryngectomy (TL) for patients with large-volume T4 and/or poor pre-treatment laryngeal functions, since such a mutilating surgical procedure has shown to be associated with better survival and, surprisingly, even superior quality of life compared to CRT or RT alone [4]
The data presented in this retrospective analysis support the hypothesis that laryngeal compartmentalization has no impact on survival in patients treated by upfront TL, but, most likely, it is a useful tool to identify ideal and unfavorable candidates for organ preservation (OP) strategies
Summary
Laryngeal cancer (LC), based on the Surveillance, Epidemiology, and End Results (SEER) database for the period 2009–2015, accounts for 0.7% of all new malignant tumors diagnosed in the UnitedStates each year. Laryngeal cancer (LC), based on the Surveillance, Epidemiology, and End Results (SEER) database for the period 2009–2015, accounts for 0.7% of all new malignant tumors diagnosed in the United. The estimated 5-year overall survival (OS) rate, considering all stages, is 60.3% and has not changed appreciably over the past several decades [1,2,3]. A majority of patients are still diagnosed with locally advanced (T3-T4) disease and evidence of regional nodal metastases, with survival rates generally inferior to 50% [4]. Two milestone studies have demonstrated that organ preservation (OP) was achievable even for advanced LC using non-surgical strategies [5,6]. Several epidemiologic studies have reported a decline in survival for patients with Chemoradiation (CRT) has become increasingly popular, causing a therapeutic paradigm shift from upfront total laryngectomy (TL) to concurrent/induction CRT.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
