Ming-Hsien Tsai1,2,3, Hui-Ching Chuang1,2, Yu-Tsai Lin1,2, Tai-Lin Huang2,4, Fu-Min Fang2,5, Hui Lu1, Chih-Yen Chien1,2,6. 1. Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan. 2. Kaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan. 3. College of Pharmacy and Health Care, Tajen University, Pingtung County 907, Taiwan. 4. Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan. 5. Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan. 6. Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
Abstract
BACKGROUND: To assess the presence of adverse pathological features at the time of salvage total laryngectomy (TL) associated with oncologic outcome. METHODS: Ninety patients with persistent/locally recurrent disease and who subsequently underwent salvage TL after definitive treatment by radiation alone (RTO) or concurrent chemo-radiation (CCRT) from 2009 to 2018 were retrospectively enrolled. Kaplan-Meier methods were used to estimate overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). RESULTS: Lymphovascular invasion (LVI), perineural invasion, positive margin, and stage IV disease were associated with worse survival in the univariate analysis. In the multivariate analysis, the presence of LVI and positive margin were both independent negative predictors in OS (LVI: adjusted hazard ratio (aHR) = 2.537, 95% CI: 1.163-5.532, p = 0.019; positive margin: aHR = 5.68, 95% CI: 1.996-16.166, p = 0.001), DSS (LVI: aHR = 2.975, 95% CI: 1.228-7.206, p = 0.016); positive margin: aHR = 11.338, 95% CI: 2.438-52.733, p = 0.002), and DFS (LVI: aHR 2.705, 95% CI: 1.257-5.821, p = 0.011; positive margin (aHR = 6.632, 95% CI: 2.047-21.487, p = 0.002). CONCLUSIONS: The presence of LVI and positive margin were both associated with poor OS, DSS, and DFS among patients who underwent salvage TL after failure of RTO/CCRT. The role of adjuvant therapy for high-risk patients after salvage TL to improve the chance of survival requires more investigation in the future.
BACKGROUND: To assess the presence of adverse pathological features at the time of salvage total laryngectomy (TL) associated with oncologic outcome. METHODS: Ninety patients with persistent/locally recurrent disease and who subsequently underwent salvage TL after definitive treatment by radiation alone (RTO) or concurrent chemo-radiation (CCRT) from 2009 to 2018 were retrospectively enrolled. Kaplan-Meier methods were used to estimate overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). RESULTS: Lymphovascular invasion (LVI), perineural invasion, positive margin, and stage IV disease were associated with worse survival in the univariate analysis. In the multivariate analysis, the presence of LVI and positive margin were both independent negative predictors in OS (LVI: adjusted hazard ratio (aHR) = 2.537, 95% CI: 1.163-5.532, p = 0.019; positive margin: aHR = 5.68, 95% CI: 1.996-16.166, p = 0.001), DSS (LVI: aHR = 2.975, 95% CI: 1.228-7.206, p = 0.016); positive margin: aHR = 11.338, 95% CI: 2.438-52.733, p = 0.002), and DFS (LVI: aHR 2.705, 95% CI: 1.257-5.821, p = 0.011; positive margin (aHR = 6.632, 95% CI: 2.047-21.487, p = 0.002). CONCLUSIONS: The presence of LVI and positive margin were both associated with poor OS, DSS, and DFS among patients who underwent salvage TL after failure of RTO/CCRT. The role of adjuvant therapy for high-risk patients after salvage TL to improve the chance of survival requires more investigation in the future.
Authors: Jacques Bernier; Jay S Cooper; T F Pajak; M van Glabbeke; J Bourhis; Arlene Forastiere; Esat Mahmut Ozsahin; John R Jacobs; J Jassem; Kie-Kian Ang; J L Lefèbvre Journal: Head Neck Date: 2005-10 Impact factor: 3.147
Authors: M P McLaughlin; J T Parsons; D A Fein; S P Stringer; N J Cassisi; W M Mendenhall; R R Million Journal: Head Neck Date: 1996 May-Jun Impact factor: 3.147
Authors: Allen S Ho; Sungjin Kim; Mourad Tighiouart; Cynthia Gudino; Alain Mita; Kevin S Scher; Anna Laury; Ravi Prasad; Stephen L Shiao; Nabilah Ali; Chrysanta Patio; Jon Mallen-St Clair; Jennifer E Van Eyk; Zachary S Zumsteg Journal: JAMA Oncol Date: 2018-07-01 Impact factor: 31.777
Authors: J T Parsons; W M Mendenhall; S P Stringer; N J Cassisi; R R Million Journal: Int J Radiat Oncol Biol Phys Date: 1995-06-15 Impact factor: 7.038