Jeroen Meulemans1,2, Jens Debacker3, Hannelore Demarsin1, Christophe Vanclooster4, Peter Neyt4, Tillo Mennes1,5, Tom Vauterin5, Wouter Huvenne3,6, Annouschka Laenen7, Pierre Delaere1, Vincent Vander Poorten8,9. 1. Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium. 2. Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium. 3. Department of Head and Skin, Ghent University, Ghent, Belgium. 4. Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, Belgium. 5. Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Brugge, Belgium. 6. Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium. 7. Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Louvain, Belgium. 8. Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Herestraat 49, 3000, Louvain, Belgium. vincent.vanderpoorten@uzleuven.be. 9. Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium. vincent.vanderpoorten@uzleuven.be.
Abstract
OBJECTIVE: We aimed to analyze oncologic outcomes and identify patterns of failure and negative prognostic factors in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx. METHODS: This was a retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018 for residual/recurrent/second primary SCC in the larynx or hypopharynx after initial (chemo)radiation. Prognostic factors for oncologic outcomes were identified using univariable and multivariable analysis. RESULTS: A total of 405 patients were included in the final analysis. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional relapse-free survival (LRFS) estimates were 47.7% (95% confidence interval [CI] 42.0-53.2%), 68.7% (95% CI 63.7-73.7%), 42.1% (95% CI 36.7-47.4%), and 44.3% (95% CI 38.8-49.7%), respectively. In a multivariable model, increasing clinical tumor stage of the residual/recurrent/second primary tumor, increasing number of metastatic cervical lymph nodes retrieved during neck dissection, hypopharyngeal and supraglottic tumor location, positive section margin status and perineural invasion were independent negative prognostic variables for OS, DSS, DFS, and LRFS. The type of second tumor was identified as an additional independent prognosticator for DSS, with local recurrences and second primary tumors having a better prognosis than residual tumor. CONCLUSIONS AND RELEVANCE: Favorable oncologic outcomes are reported after STL. Increasing clinical tumor stage, increasing number of metastatic cervical lymph nodes, hypopharyngeal and supraglottic tumor location, positive section margins, and perineural invasion are identified as independent negative prognosticators for all oncologic outcome measures.
OBJECTIVE: We aimed to analyze oncologic outcomes and identify patterns of failure and negative prognostic factors in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx. METHODS: This was a retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018 for residual/recurrent/second primary SCC in the larynx or hypopharynx after initial (chemo)radiation. Prognostic factors for oncologic outcomes were identified using univariable and multivariable analysis. RESULTS: A total of 405 patients were included in the final analysis. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional relapse-free survival (LRFS) estimates were 47.7% (95% confidence interval [CI] 42.0-53.2%), 68.7% (95% CI 63.7-73.7%), 42.1% (95% CI 36.7-47.4%), and 44.3% (95% CI 38.8-49.7%), respectively. In a multivariable model, increasing clinical tumor stage of the residual/recurrent/second primary tumor, increasing number of metastatic cervical lymph nodes retrieved during neck dissection, hypopharyngeal and supraglottic tumor location, positive section margin status and perineural invasion were independent negative prognostic variables for OS, DSS, DFS, and LRFS. The type of second tumor was identified as an additional independent prognosticator for DSS, with local recurrences and second primary tumors having a better prognosis than residual tumor. CONCLUSIONS AND RELEVANCE: Favorable oncologic outcomes are reported after STL. Increasing clinical tumor stage, increasing number of metastatic cervical lymph nodes, hypopharyngeal and supraglottic tumor location, positive section margins, and perineural invasion are identified as independent negative prognosticators for all oncologic outcome measures.
Authors: Hiang Khoon Tan; Roland Giger; Anne Auperin; Jean Bourhis; François Janot; Stephane Temam Journal: Head Neck Date: 2010-02 Impact factor: 3.147