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.

Assessment of HPV16 infection in patients with laryngeal cancer

“…In the analyzed group of laryngeal cancer patients treated with combined therapy (surgery followed by adjuvant radiotherapy), after a 5-year follow-up period the following rates were observed: LC of 69%, DFS of 61%, and OS of 45%. The obtained outcomes are concordant with relevant literature reporting 5-year LC rates ranging from 63% to 94% pT2 [3,4,5,18]. Literature data shows that radiotherapy increases the effectiveness of combined treatment by 20-30% compared to surgery alone and by 10-40% compared to radiotherapy alone [18,19,20,21].…”

“…Although in head and neck cancer patients qualification criteria for postoperative radiotherapy have been well established for many years, when analyzed individually may fail to show prognostic significance. Earlier studies revealed that what affects the outcomes of multimodality treatment is a combination of several risk factors for nodal and/or local relapse [4,6,22]. Identification of laryngeal cancer relapse risk groups in surgically treated patients can have a considerable significance for improving treatment results by precise and individual adjustment of physical parameters of radiation therapy (including total dose, radiation technique, irradiated tissue volume as well as treatment time) [4].…”

“…In the analyzed group, positive surgical margin was found in 30% of patients. According to the literature, lack of microscopic radicality is observed in 20-70% of cases [3,4].…”

“…Numerous studied showed that relapse rate after combined therapy (surgery with adjuvant radiotherapy) was lower by about 30% if negative surgical margin was achieved [3,4,21,39]. This is concordant with our earlier results; positive surgical margin in laryngeal cancer patients treated with surgery followed by radiotherapy was related to statistically significantly decreased 5-year LC rate from 91% to 76%, 5-year DFS rate from 75% to 50%, and 5-year OS rate from 79% to 61% [4]. Hinerman et al also noted decreased 5-year LRC rate from 89% to 56% with positive surgical margin [3].…”

“…Patient preferences concerning voice preservation are also of importance. Most indications for adjuvant radiotherapy are based on information obtained from the operative reports and postoperative pathology reports [3,4]. There are many publications informing on correlations between different clinicopathological parameters and relapse risk of laryngeal cancer [3,4,5,6].…”