Wznowy u pacjentów leczonych operacyjnie z powodu raka krtani

Research Progress Regarding Surgical Margins, Molecular Margins, and Prognosis of Laryngeal Carcinoma

BACKGROUND

Laryngeal carcinoma is one of the most common malignant tumors of the head and neck. Researchers have refined the study of surgical margin in the anatomical subarea of the larynx to determine the most appropriate distance of the surgical margin for laryngeal carcinoma, to achieve accurate resection of laryngeal carcinoma and to improve the possibility of retention of laryngeal function.

METHODS

A comprehensive review of the primary literature was performed from 2009 to 2019 utilizing keywords laryngeal carcinoma, surgical margin, molecular margin, and prognostic factor. Articles were included at the discretion of the authors based on novel and/or contributions to the literature.

RESULTS

The prognosis of laryngeal carcinoma significantly correlates with the status of surgical margins. Patients with positive surgical margins have higher recurrence and metastasis rates and worse prognosis. Patients with negative pathological surgical margin but with the expression or altered expression levels of one or more tumor-related molecular biomarkers had high rates of recurrence and metastasis, and poor prognosis.

CONCLUSIONS

Clinical intervention can improve the prognosis of patients with positive surgical margins. Patients with close margins should be followed closely. Among patients with negative surgical margins, patients with abnormal molecular margin results should be closely followed up. However, the specific selection of one or several molecular biomarkers as the detection index of molecular margin currently requires multicenter prospective or retrospective large sample study as guidance.

[Results of radical surgery in group of 355 patients with advanced laryngeal cancer]

INTRODUCTION

The aim of the study was to evaluate the results of radical surgery in group of 355 patients with advanced laryngeal cancer.

MATERIAL AND METHOD

The paper presents results of treatment in group of 355 patients with advanced laryngeal cancer treated in the ENT Clinical Department in Zabrze in the following years 1998-2007. The advancement stage was defined as III in 147 patients (42%), as IV in 208 patients (58%). Group of 250 patients (70%) underwent total laryngectomy and group of 105 patients (30%) underwent pharyngolaryngectomy. In the group of 327 patients (92%) operation was performed microscopically radically. 298 patients (84%) underwent postoperative radiotherapy. Median follow-up period was 5 years. Local recurrence, nodal recurrence and distant metastasis were rated as treatment failure. Treatment effectiveness was evaluated in relation to overall survival, disease-free survival, local control, locoregional control and observation free from metastases. All of these parameters were analyzed with the method of updated percentages.

RESULTS

During observation period 177 patients (50%) died. Local recurrence occurred in 47 patients (13%), nodal recurrence occurred in 19 patients (5%). Distant metastases occurred in 26 patients (7%). 5-year overall survival rate (OS) was 50%. 5-year disease-free survival rate (DFS) was 47%. 5-year local control rate (LC) was 81%. 5-year locoregional control rate (LRC) was 75%. The updated 5-year observation free from metastases rate (FFM) was 89% respectively.

CONCLUSION

Radical surgery is the chance of 5-year survival of 50% of patients with advanced cancer of the larynx and of 5-year locoregional control of 75% patients.

[The influence of selected clinical and morphological factors on treatment results of patients with advanced cancer of the larynx]

INTRODUCTION

The aim of the study was to indicate independent prognostic factors of treatment in group of patients with advanced cancer of the larynx.

MATERIAL AND METHOD

The paper presents results of univariate and multivariate analysis of selected clinical and morphological factors in the group of 355 patients with advanced laryngeal cancer treated in the ENT Clinical Department in Zabrze in the following years 1998-2007. The analysis of the results of treatment in relation to clinical and morphological features of the tumor was based on overall survival, disease-free survival, local control and locoregional control. The results of analysis allowed to indicate the independent prognostic factors for outcome in patients with advanced laryngeal cancer.

RESULTS

Univariate analysis showed that the increase of clinical advancement of laryngeal cancer was associated with worse prognosis, as well as the fact that the primary location of the tumor in supraglottis and infiltration in laryngeal part of pharynx determined the worse outcome. Univariate and multivariate analysis confirmed that the number of lymph node metastases in the surgical specimen and microscopic radical of surgery were the most important prognostic factors for survival and cure in the study group.

CONCLUSION

The strongest independent prognostic significance for all efficacy criteria have: completeness of operation and number of metastatic lymph nodes.