Abstract
Radiotherapy (RT) and transoral laser microsurgery (TLM) represent the main treatment modalities for early glottic carcinoma. Local failure is notoriously more frequent in T1b glottic cancer in comparison to T1a and T2 tumors. In this scenario, the role of anterior commissure (AC) involvement is still controversial. The aim of the present study was therefore to determine its potential prognostic power in worsening patients’ survival and outcomes. We categorized different tumor glottic fold locations with respect to the involvement of one (T1a) or both vocal cords, with or without AC involvement. We analyzed a retrospective cohort of 74 patients affected by Stage I glottic cancer, treated between 2011 and 2018 by TLM or RT at a single academic institution. There were 22 T1a (30%) and 52 T1b (70%) cases. The median follow-up period was 30 months (mean, 32.09 ± 18.738 months; range, 12–79). Three-year overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and laryngectomy-free survival (LFS) were compared according to tumor location, extension, and cT category. According to both uni- and multivariate analyses, an increased risk for recurrence in T1b with AC involvement and T1a tumors was 7.31 and 9.45 times, respectively (p-values of 0.054 and 0.030, respectively). Among the 17 recurrences, T1b with AC involvement experienced 15 tumor relapses (88.2%), thus significantly affecting both the RFS and LFS in comparison to the other two tumor subcategories (T1a, p = 0.028 and T1b without AC involvement, p = 0.043). The deteriorating prognosis in the presence of AC involvement likely reflects the need to power the hazard consistency and discrimination of the T1b category when associated with such a risk factor, thus deserving an independent T category.
Highlights
Glottic squamous cell carcinoma (SCC) represents about 75% of laryngeal malignancies [1] and arises from the glottic plane which, according to the staging manual of the American Joint Committee on Cancer (AJCC), includes three different anatomical subsites: the vocal cords, anterior commissure (AC), and posterior commissure (PC) [2].Cancers 2020, 12, 1485; doi:10.3390/cancers12061485 www.mdpi.com/journal/cancersThe five-year disease-specific survival (DSS) of T1 glottic SCC ranges between 94% and 100%, with a five-year local control of 84% [3,4]
Since the binary variables for AC involvement has led to inconsistent results in the literature [10,19], the purpose of this study was to propose a more detailed stratification for tumors involving the AC, in order to better assess its prognostic role in early glottic carcinomas and evaluate its effect on survival
Among the 85 patients treated for Stage I glottic SCC by the Head and Neck multidisciplinary team (MDT) of our Institution, 74 were enrolled in the present study
Summary
Glottic squamous cell carcinoma (SCC) represents about 75% of laryngeal malignancies [1] and arises from the glottic plane which, according to the staging manual of the American Joint Committee on Cancer (AJCC), includes three different anatomical subsites: the vocal cords, anterior commissure (AC), and posterior commissure (PC) [2].Cancers 2020, 12, 1485; doi:10.3390/cancers12061485 www.mdpi.com/journal/cancersThe five-year disease-specific survival (DSS) of T1 glottic SCC ranges between 94% and 100%, with a five-year local control of 84% [3,4]. The AC’s complex anatomy constitutes a single subsite of the larynx which, according to its embryonic origin, presents a vertical extension [7] as well as a locus minoris resistentiae due to the absence of the inner perichondrium in correspondence to the intermediate lamina of the thyroid cartilage [8,9]. In this setting, the AC has always been the object of anatomic, diagnostic, and therapeutic controversies in laryngeal oncology. Several studies have shown a significant association between AC involvement and a higher recurrence rate of glottic
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