Prognosis and Outcomes in Early Stage Glottic Carcinoma Involving the Anterior Commissure Treated with Laser CO2 Surgery: A Retrospective Observational Analysis.

Abstract

The anterior commissure (AC) is the area where the vocal cords attach to the thyroid cartilage through Broyles' ligament. Many authors argue that involvement of the anterior commissure in early stage glottic carcinoma (I, II) constitutes a risk factor for local recurrence. The objective of this study is to evaluate whether anterior commissure involvement in early stage glottis cancer is an independent risk factor for recurrence and mortality. The study included all those patients diagnosed with glottis carcinoma in stages I and II of the AJCC treated by transoral laser surgery at the Hospital San Pedro (Logroño, Spain) between 2005 and 2015. Patients were divided into two groups according to the presence (AC1) or absence (AC0) of involvement of the commissure. Of 29 patients treated, 44.8% were AC1. Patients with anterior commissure involvement had more local recurrence (p = 0.2701); higher mortality rate (p = 0.2256); lower disease-free survival (p = 0.0881) and a lower overall survival (p = 0.0331). The 5-year survival rate was 24.5% lower in patients with invasion of the anterior commissure. The involvement of the anterior commissure is an independent risk factor that should be considered in the prognosis of laryngeal cancer.