| Background:Laryngeal cancer is the second common malignance among head and neck cancers,only next to nasopharyngeal carcinoma.Although its morbidity and mortality are at a low level,the diagnosis and treatment of laryngeal cancer has always been the focal point and difficulty of head and neck surgery because of its high disability rate.The laryngeal carcinoma can be divided into three types:supraglottic,glottic and subglottic,according to the primary location of the tumor.Subglottic carcinoma is rare,and supraglottic and glottic carcinoma are the main clinical manifestations.Supraglottic carcinoma is different from glottic carcinoma.It is often found with advanced disease,with relatively low pathological differentiation,high lymph node metastasis rate and poor prognosis.Therefore,there are many differences between the treatment modalities compare to glottic carcinoma.The treatment principle of laryngeal cancer lies in improving the survival rate and preserving the laryngeal function meanwhile,in order to improve the quality of patients'life.At present,the treatment of supraglottic cancer includes surgical treatment,radical radiotherapy or concurrent chemoradiotherapy,surgery combines adjuvant radiotherapy,induction chemotherapy combines surgery and other treatment modalities.Different treatment modalities can directly affect the prognosis of patients.The analysis of prognostic factors is conducive to better understanding the nature course of this disease,and select more accurate treatment.At present,although many literatures have reported the prognostic factors of laryngeal cancer,it is difficult to know more accurately the prognostic factors of supraglottic carcinoma since supraglottic carcinoma and supraglottic carcinoma were always discussed together.Our hospital has a lot of experience in the treatment of laryngeal cancer.This data consist a large number of samples,and provides a good basis for the analysis of prognostic factors.Objective:Through the analysis of clinical data that covers a time span of forty years,to summarize the relevant factors affecting the supraglottic carcinoma prognosis,improve the possible cognitive problems,provide constructive suggestions,and provide basis and reference for future clinical research.Methods:The clinical data of 1023 consecutive patients with supraglottic carcinoma admitted to the Cancer Hospital of Chinese Academy of Medical Sciences from February 1970 to January 2010 were retrospectively analyzed.There were 775 males and 248 females.The median age of diagnosis was 58 years(14-84 years),23 cases were under 40 years old,187 cases were 41-50 years old,417 cases were 51-60 years old,301 cases were 61-70 years old,95 cases were over 71 years old.All the cases were pathologically diagnosed as squamous cell carcinoma,including 248 cases of high differentiation,482 cases of moderately differentiated,141 cases of low differentiation,4 cases of carcinoma in situ,and 148 cases of unknown differentiation.Smoking index was 0-200 in 126 cases,200-400 cases in 70 cases,400-800 cases in 410 cases,more than 800 cases in 471 cases,315 cases were alcoholics,accounting for 30.8%.T staging:T1:79 cases,T2:292 cases,T3:547 cases,T4:105 cases.N staging:N0:571 cases,N1:140 cases,N2:254 cases,N3:58 cases.Clinical stage:stage ?:50 cases,stage ?:191 cases,stage ?:412 cases,stage IV A:311 cases,stage IV B:59 cases.Treatment methods:surgery alone:464 cases,preoperative radiotherapy combined surgery:232 cases,surgery combined with postoperative radiotherapy:151 cases,radiotherapy alone:176 cases.The survival outcomes were followed up by telephone,outpatient review and follow-up letters.The death,loss of follow-up and 5 year follow-up were used as the termination points.5 year overall survival,tumor specific survival,local control rate,and neck regional control rate were calculated.Kaplan-Meier method,Log-rank single factor analysis and Cox regression model were used to calculate the survival rate and prognosis related factors.Results:the 5 year overall survival rate was 65.9%,disease specific survival rate was 72.2%,local control rate and neck regional control rate were 84.8%and 79.8%respectively.Univariate analysis showed that the overall survival rate was associated with age,tumor differentiation,T stage,N stage,clinical stage,and treatment modality.Disease specific survival rates are associated with age,tumor differentiation,T stage,N stage,clinical stage,and treatment modalities.Local control rate is related to patient age,treatment age,tumor differentiation,T staging,N staging,clinical stage,and treatment modalities.Regional control rate was related to treatment age,T stage,N stage and clinical stage.Multivariate Cox regression was used to analyze the factors that had statistical differences in univariate analysis:age,T stage,N stage,treatment modality were statistically different to overall survival.There was statistical difference between T stage,N stage,treatment modality and disease specific survival.There were statistical differences in gender,T stage,N stage,treatment modality and local tumor control rate.The treatment time,N staging and tumor regional control rate were statistically different.Conclusion:Among the supraglottic carcinoma patients,the local control rate of male patients is worse,and the follow-up should be paid attention to;the overall survival rate of elderly patients is lower,maybe because of the treatment choice and non-laryngeal death;the neck regional control rate is significantly improve than before,it is related to the strengthening of neck treatment.OS and DSS were reduced since T staging and N staging reducing local and regional control rates.The treatment was significantly correlated with OS,DSS and LC in patients.Postoperative radiotherapy increased the prognosis in OS,DSS,and LC,but showed only statistically significant difference in overall survival.The curative effect of radiotherapy alone is the worst.Surgery alone surpasses radiotherapy alone on total survival,tumor specific survival and local control.Background:The symptoms of early supraglottic laryngeal carcinoma are lack of specificity due to the relatively large space in the supraglottic area,so the patients with advanced stage are more frequent,of which the T3 is most common stage.There are few controversies about the diagnosis and treatment of patients with stage T1-2 and T4.However,a lot of questions should still be considered in the treatment of patients with stage T3.Therefore,we will focus on the diagnosis and treatment of patients with stage T3.Objective:To analyze the clinical pathological characteristics of T3 supraglottic laryngeal carcinoma and the effect of different treatment methods,and explore the clinical treatment strategies to provide the basis and reference for future clinical research.Methods:The clinicopathological data of 547 patients with stage T3 supraglottic carcinoma admitted to the Cancer Hospital of Chinese Academy of Medical Sciences from February 1970 to January 2010 were retrospectively analyzed.There were 281 males and 37 females,with a median age of 59 years.The lesions were squamous cell carcinoma,of which 130 cases were highly differentiated,263 cases were moderately differentiated,74 cases were poorly differentiated,and 80 cases were unspecifiedly differentiated.All patients were classified as T3M0 before treatment,including 231 cases in stage cNO,146 cases in stage cNl,137 cases in stage cN2,33 cases in stage cN3.There were re-classified as new N stage including 282 cases in stage N0,79 cases in stage N1,151 cases in stage N2,35 cases in stage N3 after treatment.In clinical stage,there were 362 cases of stage III,150 cases of stage IVA,35 cases of stage IVB.430 patients were identified as to be invaded in single site with a stage T3(including 195 cases with invasion of glottis space and vocal cord fixation,5 cases with invasion of medial or focal disruption of the thyroid cartilage,6 cases with invasion of postcricoid area),and the other patients(117 cases)were identified as to be invaded in more than two sites with a stage T3.Finally,Kaplan-Meier method,Log-rank single factor analysis and Cox regression model were used to calculate the survival rate and prognosis related factors.Results:The 5 year overall survival(OS),disease specific survival(DSS)and laryngeal function preservation(LFP)rates were 62,9%,69.4%and 59.3%,respectively.The total lymph node metastasis rate was 58.2%(301/547),and the rate of double neck lymph node metastasis was 16.8%(92/547).The local laryngeal control rate(LC),neck regional control rate(RC),OS,DSS and LFP were significantly different between the four methods(P<0.05),including surgery alone,preoperative radiotherapy,postoperative radiotherapy and radiotherapy alone.The 5 year-LC(49.9%),OS(40.3%),DSS(44.7%)and LFP(46.2%)was the lowest for the patients accepted radiotherapy alone.There were no significant differences about the 5 year-LC(89.9%,95.3%and 89.2%),OS(68.9%,71.8%and 75%),and DSS(78.5%,77%and 77.1%)among the patients accepted surgery alone,preoperative radiotherapy,postoperative radiotherapy,respectively(P>0.05).Meanwhile,the 5 year OS(66.8%),DSS(73.8%),LC(91.2%),RC(81.3%)and LFP(79.8%)of patients with single invasion of preepiglottic space were significantly higher than those with invasion of paraglotic space and vocal fixation or more than two parts(P<0.05),and the 5 year LC(80.3%)and LFP(57.8%)for the patients with invasion of paraglotic space and vocal fixation alone were significantly lower than those with preepiglottic space invasion alone(P<0.05),but the 5 year OS(60.4%)and RC(72.5%)were the worst for the patients with invasion of more than two parts.Finally,the 5 year RC(84.7%,83.5%),OS(69.9%,70.1%)and DSS(76%,79.7%)in cNO and cNl patients were comparable,which were significantly higher than those in cN2 and cN3(P<0.05).Conclusion:Surgical treatment is the first choice for supraglottic carcinoma in stage T3.Most patients can undergo partial laryngectomy,and the final choice of surgical procedure depends on the site of tumor invasion.The high incidence of cervical lymph node metastasis has a great impact on prognosis,so neck treatment should be performed at the same time.Preoperative radiotherapy can effectively reduce the tumor,but the curative effect and indications of postoperative radiotherapy need to be further clarified. |
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