Supraglottic Laryngeal Carcinoma Research Articles

Treatment discordance in the utilization of neck dissection for stage I-II supraglottic tumors.

In 2018, the National Comprehensive Cancer Network treatment guidelines began recommending the use of neck dissection during surgical management of stage I-II supraglottic laryngeal squamous cell carcinoma (LSCC). Trends and factors associated with the use of neck dissection during larynx-preserving surgery for patients with cT1-2, N0, M0 supraglottic LSCC in the National Cancer Database (2004-2020) were evaluated using multivariable-adjusted logistic regression. Of the 2080 patients who satisfied study eligibility criteria, 633 (30.4%) underwent neck dissection. Between 2018 and 2020, the rate of neck dissection was 39.0% (114/292). After multivariable adjustment, academic facility type, undergoing biopsy prior to surgery, and more radical surgery were significant predictors of receiving neck dissection. The results of this national analysis suggest that the utilization of guideline-concordant neck dissection for management of stage I-II supraglottic LSCC remains low and highlight the need to promote the practice of neck dissection for this patient population.

The minimal number of examined lymph nodes for accurate nodal staging and favorable prognosis in T1-2 supraglottic laryngeal squamous cell carcinoma

ObjectiveThe study aimed to investigate the minimal number of examined lymph nodes (ELNs) for accurate assessment of lymph node status and favorable prognosis in patients with stage T1-2 supraglottic laryngeal squamous cell carcinoma (LSCC) who received radical resection. MethodsPatients with stage T1-2 supraglottic LSCC from the Surveillance, Epidemiology, and End Results (SEER) database and the Chinese Academy of Medical Sciences, Cancer Hospital/National Cancer Center (NCC) were reviewed. The association of the ELN count with the identification of nodal metastasis and overall survival (OS) was analyzed using a multivariate regression model. Locally weighted scatterplot smoothing fitting curve and the ‘changepoint’ package were adopted to identify the optimal cut points using R. ResultsA total of 429 patients from the SEER database and 53 patients from NCC were enrolled. The probability of identifying nodal metastasis was positively related to the ELN count. For patients diagnosed with pathological stage N0 (pN0) disease, the mortality risks rapidly decreased when the amount of ELNs exceeded ten, and those with ELNs >10 had better OS. ConclusionAn adequate amount of ELNs benefits precise nodal staging in patients with stage T1-2 supraglottic LSCC. Ten lymph nodes are the minimum number of ELNs. For pN0 patients, an ELN count ≤10 is an unfavorable prognostic factor.

Frequency of Regional Metastasis in Supraglottic Carcinoma of Larynx

Background: Incidence of laryngeal cancer still high among the upper aerodigestive tract. 85–95% of these laryngeal cancer is squamous cell carcinoma. Locally advanced laryngeal cancer metastasize more. Supraglottic cancers have the highest prevalence of regional metastases among laryngeal cancers.
 Objectives: To evaluate the frequency of regional metastasis in supraglottic carcinoma of larynx.
 Methods: This cross-sectional study was conducted including 40 patients with supraglottic Carcinoma of Larynx over a period of six months from June to November 2014 in the ENT and Head Neck Surgery department of Rajshahi Medical College Hospital, Rajshahi. Those with glottic carcinoma, subglottic carcinoma, hypopharyngeal carcinoma, metastatic neck node without any primary site (Occult primary) were excluded from the study. FNAC from neck node was done in patients with palpable neck node.
 Results: Most of the patients 19 (47.5%) was in age group 50-60 years with mean age 54.5±13.2 years. Most of the patients present with more than one symptom & the commonest presenting symptoms was cough and irritation 35(87.5%) followed by dysphagia 26(65%) and change of voice 24(60%). A good number of patients, 16(40%) was presented with neck swelling. Among 40 patients, 16(40%) had their regional lymph nodes involved. Level-II lymph nodes were involved in higher number of cases 10(62.5%). Nodes in early stage of involvement were found in most cases 9(56.5%). Homolateral involvement of nodes was found in most cases 13(81.3%).Most of the supraglottic growths 22(55.0%) was exophytic in appearance. The common site of supraglottic carcinoma in this study was aryepiglottic fold and arytenoids 20(50.0%). Among the patients, 31(77.5%) had T2 tumours. Amon them, 16(40%) were in stage-III followed by stage-II 10(25%).
 Conclusion: Regional metastasis is a very useful prognostic indicator. Supraglottis is rich in lymphatic drainage and a high proportion of these tumors spread to lymph nodes.
 Bangladesh J Otorhinolaryngol 2022; 28(2): 180-185

Role of transoral robotic surgery in surgical treatment of early-stage supraglottic larynx carcinoma.

There are several options for primary surgical treatment of early-stage supraglottic squamous cell carcinoma (SCC), including transoral robotic surgery (TORS). The purpose of this study was to compare outcomes of TORS to open partial laryngectomy and transoral laser microsurgery (TLM). Patients with clinical classification T1-2 supraglottic SCC diagnosed 2010-2019, treated with TORS, open partial laryngectomy, or TLM in the National Cancer Database were selected. One thousand six hundred three patients were included: 17% TORS, 26.5% TLM, 56.5% open. TORS patients had the lowest rates of adjuvant treatment (28.4% vs. TLM: 45.0%, open: 38.5%, p < 0.001), and lower positive margin rates than TLM (16.9% vs. 30.5%, p < 0.001). Thirty-day and ninety-day post-operative mortality did not differ between the approaches. Five-year survival was higher following TORS compared to open surgery (77.8% vs. 66.1%, p=0.01); this difference persisted following matched-pair analysis. TORS may be a safe and effective surgical approach for early-stage supraglottic SCC in appropriate patients.

Comparison between transoral radiofrequency coblation surgery and open partial laryngectomy for the treatment of supraglottic laryngeal carcinoma

Objective: To explore the feasibility and efficacy of radiofrequency coblation assisted transoral surgery for the treatment of supraglottic laryngeal carcinoma by comparing with concurrent patients treated with conventional transcervical approach. To clarify the advantages of different surgical methods and to summarize the experience of supraglottic carcinoma radiofrequency ablation. Methods: Forty-six patients with supraglottic laryngeal carcinoma treated in department of otorhinolaryngology head and neck surgery, Peking University First Hospital from March 2014 to January 2021 were analyzed retrospectively. Among them(43 males, 3 females, aged from 45 to 79 years old), 23 patients were treated with radiofrequency coblation and 23 patients with partial laryngectomy with conventional transcervical approach. The operation time, intra-operative blood loss volume, recovery time, inpatient total medical cost and follow-up information of the two groups were analyzed. SPSS 26.0 software was used for statistical analysis. Results: There were no significant differences in age, gender, TNM staging,tumor staging and postoperative radiotherapy between the two groups (all P>0.05).The operation time, intra-operative blood loss volume, recovery time, inpatient total medical cost of the RFC-TOS group were110.0(60.0,150.0)min,5.0(5.0,30.0)ml,3.0(2.0,5.0)days,6.0(4.0,14.0)days and 26 100.7(16 145.5,47 044.4)yuan. The data of conventional transcervical approach group were 205.0(156.5,272.3)min, 150.0(50,200) ml, 18.0(16.3,22.8)days and 56520.1(440 992.5,67 109.9)yuan, (Z=-4.03, -4.94, -4.97, -4.98 and -4.13;all P<0.001).The 5-year local control rate, disease-specific survival rate and overall survival rate of the two groups were 86.96%,95.65%,91.30% and 86.96%,91.30%,73.90% renspectively, which had no significant difference between the two groups(all P>0.05). Conclusions: Compared with conventional transcervical surgeries, RFC-TOS could be a reliable new surgical option for organ-function preservation strategy in the treatment of supraglottic laryngeal carcinoma.The RFC is a suitable new technique and deserving more multi-center clinical trials for its clinical promotion.

Early death in supraglottic laryngeal squamous cell carcinoma: A population-based study.

Supraglottic laryngeal squamous cell carcinoma (LSCC) is the second most common type of laryngeal cancer with a poor prognosis. Current population-based estimates of the early death rate and associated factors for early death of supraglottic LSCC are lacking. The purpose of this study was to assess the early death rate and related factors for early death in patients with supraglottic LSCC. We identified 3733 adult patients diagnosed with supraglottic LSCC between 2010 and 2017 for whom the vital status at 3months was known from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were staged according to the seventh edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The early death (survival time ≤ 3months) rate was calculated. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the early death rate. 313 (8.38%) of the 3733 patients died within 3months of diagnosis of supraglottic LSCC. Of these, 225 patients died from cancer-specific causes. Multivariate logistic regression analyses confirmed that advanced age, male sex, advanced T stage, advanced N stage, advanced M stage, and not undergoing treatment (surgery, radiotherapy, and chemotherapy) had significant correlations with all-cause early death in supraglottic LSCC. In addition, advanced age, advanced T stage, advanced N stage, advanced M stage, and not undergoing treatment (surgery, radiotherapy, and chemotherapy) were significantly correlated with cancer specificity in supraglottic LSCC. When a tumor is newly diagnosed, we should pay close attention to sex, age, unmarried status and AJCC TNM staging to quickly detect supraglottic LSCC patients with a tendency toward early death. These findings have implications for precise prognosis prediction and individualized and personalized patient counseling and therapy.

Health-Related Quality-of-Life Outcomes after Transoral Robotic Surgery for T1 and T2 Supraglottic Laryngeal Carcinoma Compared to the Transcervical Open Supraglottic Approach

Introduction: This prospective controlled study evaluated and compared health-related quality of life (HRQOL), after transoral robotic supraglottic laryngectomy (TORSGL) versus transcervical open supraglottic laryngectomy (TCOSGL) in patients with T₁ and T₂ supraglottic laryngeal carcinoma (SLC). Methods: The TORSGL group comprised 14 patients, and the TCOSGL group comprised 13 patients. All 27 patients completed the European Organization for Research and Treatment of Cancer 30-item core quality-of-life questionnaire version 3.0 (EORTC QLQ-C30), the European Organization for Research and Treatment of Cancer head-and-neck cancer-specific module (EORTC QLQ-H&N35), before treatment and during the early and the late postoperative periods. Results: The present prospective study demonstrated the near-term postoperative HRQOL of patients with T₁ or T₂ SLC treated with TORSGL (Group A) or TCOSGL (Group B). On comparison of EORTC QLQ-C30 data for the two groups in the early postoperative period, all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B and in the late postoperative period, other than the cognitive function score (p = 0.450), all functional subscale scores and global health status scores were statistically significantly lower (all p < 0.05) in Group A than in Group B. On comparison of the EORTC QLQ-H&N35 data for the two groups in the early postoperative period, except for the teeth problems scale score (p = 0.061), all symptom scale scores were statistically significantly lower in Group A than in Group B (all p < 0.05) and in the late postoperative period, the speech, social eating, social contact, and coughing scale scores were statistically significantly lower (p = 0,0215, p = 0.021, p = 0.01, p = 0.011, respectively) in Group A than in Group B. HRQOL parameters recovered in the late postoperative period in both groups; recovery was better in Group A. Discussion/Conclusion: This study suggested that TORSGL may provide patients with a better HRQOL than those TCOSGL, especially in the early period, but also in the late period.

En Bloc Resection of Supraglottic Carcinomas with Transoral Laser Microsurgery.

Objective:Complete en bloc supraglottic tumor excision with transoral laser microsurgery (TLM) can be achieved with good postoperative outcomes. We report surgical feasibility and the postsurgical outcomes of en bloc resection of supraglottic laryngeal squamous cell carcinomas (LSCC) with TLM.Methods:Seventeen patients who underwent TLM for supraglottic laryngeal cancer were included in the study. Demographic and pathological data, clinic and follow-up outcomes of the patients were reviewed and analyzed.Results:Type 1 TLM was performed in three patients, type 2a in one patient, type 3b in 12 patients, and type 4b in one patient. Negative surgical margins were achieved in all of the cases. Re-excision or any adjuvant treatment for positive resection margins was not required in any of the cases. Eight patients received adjuvant radiotherapy due to lymph node metastasis. Mean follow-up time was 33.8±15.7 months (range: 10–65 months). None of the patients had recurrence or distant metastasis.Conclusion:The transoral approach with the use of CO2 laser and microscopy offers complete tumor excision for treating supraglottic LSCC. The three-dimensional structure of the supraglottis can be achieved with adequate exposure. En bloc resection is possible with safe margins.

Aberrant expression profiles and bioinformatic analysis of CAF-derived exosomal miRNAs from three moderately differentiated supraglottic LSCC patients.

BackgroundAberrant expression of exosomal miRNAs has emerged as a research hotspot. However, no studies have been conducted on the dysregulation of exosomal miRNAs derived from cancer‐associated fibroblasts (CAFs) in supraglottic laryngeal squamous cell carcinoma (SLSCC).MethodsCancer‐associated fibroblasts and paired normal fibroblasts (NFs) from SLSCC patients were cultured, and exosomes in the culture supernatants were collected and identified. Exosomal miRNA expression was compared in each pair of CAFs and NFs by next‐generation sequencing, and expression of selected exosomal miRNAs was validated by reverse transcription‑quantitative PCR. Four online bioinformatic algorithms predicted the potential target genes of aberrantly expressed miRNAs, while gene ontology and Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway enrichment and network analysis identified downstream target genes and their interactions.ResultsThree pairs of CAFs and NFs were successfully cultured and purified. CAF‐derived exosomal miRNAs were mostly downregulated and included miR‐656‐3p, miR‐337‐5p, miR‐29a‐3p and miR‐655‐3p; however, some, including miR‐184‐3p, miR‐92a‐1‐5p, miR‐212‐3p and miR‐3135b, were upregulated. Bioinformatics analysis revealed involvement of these miRNAs in biological processes, cellular components and molecular functions. KEGG analysis revealed the top 30 pathways involvement in cancer initiation and progression and in cell cycle regulation. An interaction network showed miR‐16‐5p, miR‐29a‐3p, miR‐34c‐5p, miR‐32‐5p and miR‐490‐5p as the top five miRNAs and CCND1, CDKN1B, CDK6, PTEN and FOS as the top five target genes.ConclusionsSLSCC patients showed aberrant expression of CAF‐derived exosomal miRNAs. The top five miRNAs and their target genes may jointly constitute a carcinogenic tumour microenvironment and act as biomarkers for SLSCC intervention.

Use of monopolar microelectrodes and radiofrequency in the treatment of arytenoid edema after partial horizontal laryngectomy and radiotherapy.

We evaluated the tissue reduction effects using monopolar microelectrodes (MME) coupled to a radiofrequency (RF) generator in arytenoid edema caused by postoperative radiotherapy in larynx. This is a retrospective transversal study, which included 15 patients with supraglottic laryngeal carcinoma. All the patients had undergone a partial horizontal laryngectomy and bilateral neck dissection followed by postoperative radiotherapy. The studied group of patients presented laryngeal stenosis defined by arytenoid edema as a complication, requiring permanent tracheostomy for mean of 12 months. The surgical procedure for treating the edema was the transoral approach of the larynx by microlaryngoscopy under general anesthesia; using 180° MME coupled to a 4-MHz RF generator delivering 15 W using coagulation mode. A total of 11 (73%) patients were decannulated. The median time for decannulation was 10 weeks. No complications were reported. After 2 years of follow-ups, no case of re-stenosis was found. MME coupled to RF is a very efficient method to treat arytenoid edema after adjuvant radiotherapy.

Endoscopic surgery for supraglottic laryngeal carcinoma by coblation

Endoscopic surgery for supraglottic laryngeal carcinoma by coblation

Induction Chemotherapy Plus Simultaneous Modulated Accelerated Radiation Therapy in Non-operative Hypopharyngeal and Supraglottic Laryngeal Squamous Cell Carcinoma: Long-Term Outcome of a Prospective Phase 2 Study.

Background: To evaluate the toxicities and long-term outcomes of induction chemotherapy (ICT) plus simultaneous modulated accelerated radiation therapy (SMART) in non-operative hypopharyngeal and supraglottic laryngeal squamous cell carcinoma (SCCH/L).Materials and Methods: This was a prospective phase 2 study. Patients diagnosed with SCCH/L, aged from 18 to 75, staged from III to IVB in accordance with the AJCC 2010 criteria, and refusing surgery were eligible. The patients were treated with 2–3 cycles of docetaxel-cisplatin-based ICT and SMART combined with 2–3 cycles of cisplatin-based concurrent chemotherapy. The prescription dose to the primary tumor and metastatic nodes was 69 Gy in 30 fractions. Acute and late toxicities were assessed according to the established Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria, and long-term outcomes were analyzed.Results: Between February 2013 and June 2015, 55 newly diagnosed SCCH/L patients were enrolled. No grade 2 or worse acute xerostomia was noted. The incidences of grade 3 acute dermatitis, oral mucositis, and pharyngoesophagitis were 12.7, 3.6, and 12.7%, respectively. The median follow-up time was 48 months (range 5.5–74 months). The main late toxicity was hoarseness or sore throat, with an incidence of 32.7%. The 5-year functional larynx-preservation survival was 51.5%. The 3- and 5-year locoregional control and overall survival were 58.2, 51.5, 63.6, and 54.1%, respectively.Conclusions: The ICT plus SMART with a regimen of 69 Gy/30 F for the treatment of SCCH/L demonstrated acceptable severe toxicity, satisfactory long-term outcomes, and laryngeal function preservation.

Functional and Oncological Outcomes of Open Partial Laryngectomy vs. Transoral Laser Surgery in Supraglottic Larynx Cancer.

The aim of the presented study was to evaluate the outcomes of open partial laryngectomy (OPL) versus transoral laser surgery (TLS) in patients operated on for supraglottic laryngeal carcinoma based on functional parameters (duration of hospitalization, oral nutritional status and duration of transition to oral feeding, weaning status and duration after tracheotomy, and postoperative voice results) and oncological results (overall survival rate, disease-specific survival rate, recurrence, and presence of second primary tumors) in both groups. All laryngeal carcinoma patients who had undergone either OPL or TLS in the period from January 2012 to March 2017 in our center and were followed-up at least for 36 months were included in the study. Statistical analyses were carried out using the t-test and the Mann-Whitney U test to compare the means, and the Kaplan-Meier test for survival analysis. Fifty patients (44 males and 6 females) met the study criteria, of whom 31 had undergone OPL and 19 TLS. Patients that underwent TLS had less tracheotomy needs, needed shorter hospitalization periods, and transitioned to oral feeding earlier, compared to those that underwent OPL. There were no significant differences between the two groups based on oral feeding rates and voice outcomes. The impact of TLS and OPL on organ preservation in supraglottic laryngeal cancer were comparable. For local recurrences, repeated endolaryngeal laser surgeries and adjuvant treatments could be used in the TLS patient group. There were no significant differences between the two groups based on overall survival rate and disease specific survival rate. Although no significant differences were found in our study between the two surgical procedures in terms of oncological outcomes, TLS appeared to produce better functional outcomes in supraglottic laryngeal carcinoma than OPL.

Postoperative Radiotherapy Omitting Level Ⅳ for Locally Advanced Supraglottic and Glottic Laryngeal Carcinoma.

Background:Cervical lymph nodes metastases are one of the most significant prognostic factors in patients with laryngeal carcinoma, whether treatment by surgery or by radiotherapy. The current study retrospected the postoperative radiotherapy of locally advanced supraglottic and glottic laryngeal carcinoma (at a greater risk of lymph node metastasis) to determine the effect of radiotherapy excluding cervical level Ⅳ lymph nodes.Methods:Patients of supraglottic type and glottic type were irradiated with level Ⅳ from January 2012 to June 2013, without level Ⅳ from July 2013 to December 2014, according to physicians’ decision. Ninety-three patients were selective neck irradiation (SNI) of levels Ⅱ-Ⅳ (Group A) and 87 patients were SNI of levels Ⅱ and Ⅲ (Group B). The comparison between Group A and Group B was made with observation of clinical risk of recurrence and radiation complications, as well as overall survival (OS), progress-free survival (PFS) and regional nodal recurrence-free survival.Results:No remarkable difference was observed in the distribution of recurrence, levels of relapse, OS, PFS and regional nodal recurrence-free survival between the 2 groups (p > 0.05). Mean radiation dose at level Ⅳ, thyroid and cervical esophagus showed significant difference between the 2 therapeutic groups (p < 0.01). As regard radiation complications, no significant difference was found in radiation dermatitis of any grade between the 2 groups (p > 0.05). However, there was remarkable difference in clinical hypothyroidism and radiation esophagitis between Group A and Group B (p < 0.05).Conclusions:Radiotherapy after surgery omitting level Ⅳ may improve the quality of life in patients with locally advanced supraglottic and glottic laryngeal carcinoma, won’t worsen the prognosis as well.

Clinicopathological Study of Supraglottic Carcinoma of Larynx

Introduction: Incidence of supraglottic carcinoma is more common which may be related to poor nutrition with personal habit like smoking and chewing habit of betel leaves with various ingredient.&#x0D; Objectives: To find out the incidence, age and sex distribution, occupation and clinical presentation of supraglottic carcinoma of larynx.&#x0D; Materials and Methods: In this prospective study, 30 patients of supraglottic carcinoma are collected from department of ENT and Head-Neck surgery, Combined Military Hospital, Dhaka from July 2012 to July 2013.&#x0D; Results: Patients belongs to different age groups, ranging from 40 to 80 years and maximum patients are in 50 to 60 years of age. The male to female ratio is 5:1. In this series, majority of patients are smoker (66.66%). Most of them are from low socio-economic group. The incidence of lymph node involvement is 40% (12 cases). Maximum number of patients presents with exophytic lesion (60%). Ulcerative lesions are 26.66% and infiltrative lesions are 13.33%. Maximum numbers of patients have T2 lesions (80%). T1 lesions are 20%. In this study all cases are histopathologically confirmed to be squamous cell carcinoma (100%). In this study, all cases are M0 state.&#x0D; Conclusion: Supraglottic carcinoma occurs between 40-80 years of age, more common in 5th and 6th decades. Chewing betel nut and tobacco should be avoided to reduce the risk of supraglottic carcinoma and early presentation &amp; diagnosis will improve the prognosis of patients.&#x0D; JAFMC Bangladesh. Vol 15, No 2 (December) 2019: 224-226

Analysis and management of occult cervical lymph node metastasis of cN0 supraglottic laryngeal carcinoma

Objective:To explore the rule of occult cervical lymph nodes metastasis in clinically node negative（cN0） supraglottic laryngeal carcinoma. Method:The clinical data of 185 patients with cN0 supraglottic laryngeal carcinoma were analyzed retrospectively. All patients received surgical resection of the primary lesions and lateral neck dissection. The survival curve was analyzed by Kaplan-Meier method, and the survival rate was compared by chi-square test and log rank test. Result:The total incidence of occult cervical lymph nodes metastasis in cN0 supraglottic laryngeal carcinoma was 38.9％（72／185）, the unilateral and bilateral neck occult metastases were determined in 51 cases（27.6%） and 21 cases（11.4%） respectively. A total of 266 positive nodes were collected, and the distributions of the 266 positive nodes were as follows: 220（82.7%） in level Ⅱ, 42（15.8%） in level Ⅲ, and 4（1.5%） in level Ⅳ. The occult metastasis rates of bilateral cervical lymph nodes with different degrees of differentiation were 37.5%（12/32） for poorly differentiated squamous cell carcinoma, 7.4%（6/81） for moderately differentiated squamous cell carcinoma, and 4.2%（3/72） for high differentiated squamous cell carcinoma; the occult metastasis rates of bilateral cervical lymph nodes at T1, T2, T3, T4 were 0, 2.7%（2/73）, 8.1%（6/74）, 46.4%（13/28）, respectively，and the difference was statistically significant（P<0.01）. Conclusion:cN0 supraglottic laryngeal carcinoma has a high rate of occult cervical lymph nodes metastasis, and its metastatic area is mainly located in level Ⅱ-Ⅲ, so the primary tumor of the laryngeal carcinoma and the neck lymph node of level Ⅱ-Ⅲ should be managed at the same time. For the cN0 patients with poorly differentiated squamous cell carcinoma or T4 staging should be treated with bilateral neck dissection.

Screening of molecular markers of induced chemotherapy in supraglottic laryngeal squamouscell carcinoma.

ObjectiveTo investigate the expressions of MAPK10, c-Jun and Itga6 in laryngeal carcinoma and its influence on the sensitivity to docetaxel, cisplatin and 5-fluorouracil (TPF) chemotherapy.MethodsFifty-seven patients with supraglottic squamous cell carcinoma, who were treated by two cycles of TPF induction chemotherapy in our hospital, were enrolled in this study and divided into groups by chemotherapy resistance or chemotherapy sensitivity. The expressions of mRNA and protein of MAPK10, c-Jun and Itga6 in tumor tissues were evaluated by immunohistochemistry. The consistency of mRNA and protein expressions was tested, and the relation with the clinicopathological features was analyzed.ResultsThe positive rates of MAPK10 andc-Jun in the tumor tissues of the sensitive group were significantly higher than those of there assistant group, which was 90.48% and 100.00%, respectively. The expression rate of Itga6 was significantly higher in the resistant group, which was 83.33% (P < 0.05). The mRNA levels of MAPK10 and c-Jun were significantly lower in the resistant group than in the sensitive group, whilethemRNA levelof Itga6was significantly higher in the resistant group (P < 0.05). The protein expressions of MAPK10, c-Jun and Itga6 were consistent with their mRNA expressions (P < 0.05). The expressions of MAPK10, c-Jun and Itga6 were not correlatedwithage, gender and tumor diameter (P > 0.05). However, the expressions of MAPK10 and c-Jun were negatively correlated withclinical stage and pathological grading (P < 0.05). Negative correlations between MAPK 10 and Itga6, and between c-Jun and Itga6in tumor tissues were found by Spearman'srank correlation coefficient (P < 0.05). The correlation was also negative in the resistant tumor tissues (P < 0.05).ConclusionThe MAPK10 and c-Jun expressions were down-regulated, while the Itga6 expression was up-regulated in the chemo-resistant laryngeal carcinoma, and the expression levels of different factors were correlated witheach other. These factorsmight be important biomarkers for predicting outcomes of TPF chemotherapy in laryngeal carcinoma in the future.

Rational choice of neck dissection in clinically N0 patients with supraglottic cancer.

The mainstay treatment of the neck for clinically negative neck (cN0) supraglottic laryngeal carcinoma (SGLC) is neck dissection. However, the optimal extent remains controversial. This study's purpose is to determine whether ipsilateral level II-III neck dissection is appropriate for cN0SGLC patients. The records of 220 consecutive untreated cN0SGLC patients were retrospectively reviewed. Relevant factors related to occult and contralateral neck metastasis were analyzed and the distribution of metastasis was described. Seventy-seven and 143 patients underwent unilateral and bilateral neck dissection, respectively. The rate of occult neck metastases was 21.4%. The histologic differentiation was an independent risk factor for occult neck metastasis. In the bilateral neck dissection group, the incidence of contralateral neck metastasis of patients with noncentral tumors was 0.7%. Moreover, only 1.7% of patients had positive nodes at level IV, and no isolated nodal metastases existed in level IV. Ipsilateral level II-III neck dissection is feasible for patients with noncentral cN0SGLC.

Predictors of Occult Lymph Node Metastasis and Prognosis in Patients with cN0 T1–T2 Supraglottic Laryngeal Carcinoma: A Retrospective Study

Background: This work aimed to explore the predictors of lymph node metastasis (LNM) and analyze the prognosis of patients with clinically node-negative (cN0) T1–T2 supraglottic laryngeal carcinoma (SGLC). Methods: Data for 130 patients with cN0 T1–T2 SGLC who initially underwent surgery were retrospectively reviewed. Occult LNM incidence, relevant factors, and prognosis were analyzed. Results: Of the 130 patients with cN0 T1–T2 SGLC, 21 (16.2%) had occult LNM. Based on univariate and multivariable regression analyses, male sex and poor tumor differentiation predicted the incidence of occult LNM. The incidence of occult LNM was 20.9% in males and 5.1% in females (p = 0.035). Patients with poorly differentiated tumors had a higher incidence of occult LNM (42.9%) than patients with well-differentiated (10.3%) and moderately differentiated tumors (14.3%; p < 0.05). Thirteen patients (10%) had cervical recurrence, and all had T2 tumors (p = 0.02). The 5-year disease-specific survival rates were 70 and 90% for patients with and without LNM, respectively (p = 0.000). Conclusions: Sex and tumor differentiation are potential predictors of occult nodal disease. Female patients with cN0 T1–T2 SGLC are less likely than male patients to have neck metastasis. Poorly differentiated tumors are associated with the frequency of neck metastasis, and selective neck dissection is strongly recommended for these tumors.

Frequency of Lympnode Metastasis in Supraglottic Ca Larynx

Introduction: To observe the association between the level of lymph node metastasis and the T- stage and to evaluate the N- stage in supraglottic carcinoma of larynx.&#x0D; Materials and Methods: A prospective cross-sectional study was carried out on 80 consecutive cases of supraglottic carcinoma larynx in three tertiary level hospital in Dhaka during July'2009 to March 2011.&#x0D; Results: The highest number of patients were in the age group 5th and 6th decades. Male to female ratio was 9:1. Topographically 70 cases (87.5%) had lesions involving epiglottis, 5 cases (6.25%) in aryepiglottic fold and 5 cases (6.25%) had lesions at false cord. Majority cases were histopathologically confirmed squamous cell carcinoma (95%) and among them 46 cases (57.5%) had well differentiated. Cervical metastatic lymph nodes were found 40% (32 cases) where level-II was most common. This was most frequent in early supraglottic(T1&amp;T2) carcinoma of larynx (86.25%), P=0.008. A positive correlation was found between the T stage of primary tumours and frequency of cervical lymphadenopathy. Lymph node metastasis were 4.77% in T1, 37.50% in T2, 71.43% in T3 and 91.67% in T4. In early stage lymph node involved 93.75% in Level- II, 6.25% in Level- III &amp; in advanced stage 100% in Level - II, 62.5% in Level - III and 25.0% in Level - IV. Distribution of study cases (31.25%) in stage-II, 25% in stage-I, 22.50% in stage-Ill and 21.25% were in stage-IV.&#x0D; Conclusion: Result of this study may help the clinician for planning of treatment of this malignant diseases as well awareness.&#x0D; Medicine Today 2019 Vol.31(2): 72-75