Prognostic factors in laryngeal cancer patients submitted to surgical treatment

Abstract

The authors studied some demographic, clinical, pathologic, and therapeutic variables in relation to the disease-free interval (DFI) and to the overall survival of laryngeal cancer patients. The patient population consisted of 278 consecutive cases of primary laryngeal cancer who had been admitted to four head and neck surgery services in Sao Paulo and Curitiba (Brazil) between 1973 and 1986. All patients had surgical treatment. Although several variables exhibited individual associations with survival, only a few were deemed to have independent prognostic value using multivariate regression techniques based on Cox's proportional hazards model. The primary tumor stage (T index) represented the variable with the highest predictive strength with respect to survival. Hazard ratios for the risk of disease recurrence were 2.3 (T2-3 vs. T1) and 4.3 (T4 vs. T1). Hazard ratios for the risk of death were 1.6 (T2-3 vs. T1) and 3.3 (T4 vs. T1). The following additional factors were also independently associated with the DFI: age, site of primary tumor (transglottic, glottic, or supraglottic), extracapsular spread of lymph node metastasis, surgical margins, type of paratracheal node dissection, and prior tracheostomy. Except for extracapsular spread, the same factors related to the DFI were also significantly related to the overall survival. Race, sex, N-stage, vascular embolization, and histological grade were other independent predictors of the risk of death.

Prognostic determinants in supraglottic carcinoma: Univariate and Cox regression analysis

“…Performance status and the development of a metachronous tumor were additional parameters correlated with the RR of death for absolute survival. Although limited by the retrospective nature of the study, the results presented here are in keeping with much of the data reported so far 7,9,10,12,17,27,28,32 and could well represent a valid starting point for new prospective confirmatory studies.…”

“…Degree of differentiation is the most extensively investigated histopathologic parameter, 6,7,10,12,14,17,19,22,26,27,29,30,32 but only a few studies have been able to document its impact on prognosis. 6,26,29 Even in our study, degree of differentiation was significantly correlated with survival in the univarate (Table 3) but was not related with an increased RR of death in the multivariate analysis.…”

Diagnostic delays in laryngeal carcinoma: Professional diagnostic delay is a strong independent predictor of survival

“…Multivariate analyses were undertaken using the stepwise Cox regression model with disease-specific survival from the diagnosis as the outcome measure. In addition to the patient delay (<3 months vs Ն3 months) and the professional delay (<6 months vs 6-12 months vs Ն12 months), the following factors that have earlier been found to be important prognostic factors in laryngeal cancer were included in the model: TNM classification, [3][4][5] site of the tumor, 3,4 age, 3 (<65 vs Ն65 years), and smoking 5,11 (yes or no). TNM stage was dichotomized as stages I-III vs stage IV, because according to Breslow's test, survival at stage IV was substantially lower than at the other stages.…”

“…2 Several studies have confirmed that stage is the most important prognostic factor. [3][4][5] The reason for a patient to be seen with an advanced stage cancer may be due to rapid tumor growth, but also the patient's delay in seeking medical advice or misdiagnosis by the primary care physician may be important. There may be no alarming early symptoms, or the patient may be ignorant or deny the malignancy and therefore postpone the decision to seek medical help.…”

Bilateral radical neck dissection: Results in 193 cases

“…When regional lymph nodes are involved, however, especially those contralateral to the primary lesion, the survival rates decrease by at least 50% [9,[19][20][21]. In patients with clinical evidence of cervical lymph node involvement, treatment consists mostly of radical unilateral or bilateral neck dissection, and resection of primary tumor combined with postoperative radiotherapy [22,23].…”