Prognostic factors in T3,N0-1 glottic and transglottic carcinoma. A multifactorial study of 221 cases treated by surgery or radiotherapy.

OBJECTIVE

To evaluate prognostic factors in patients with T3,N0-1 glottic and transglottic carcinoma treated in a single institution.

DESIGN

Retrospective, nonrandomized case series.

SETTING

Tertiary case referral centers, ambulatory or hospitalized care.

PATIENTS: Two hundred twenty-one consecutive cases of stage III glottic or transglottic squamous cell carcinoma. Tumor stage was T3,N0,M0 in 167 cases and T3,N1,M0 in 54 cases.

INTERVENTIONS: Surgery in 176 cases and radiotherapy in 45 cases.

MAIN OUTCOME MEASURES: Recurrences and survival (multivariate).

RESULTS

Almost 7% of the patients who underwent surgery and 39.6% who had radiotherapy had local recurrences. Recurrences in the neck were seen in 16.4% of the patients who underwent surgery and in 10.5% of those who had radiotherapy. Distant metastases were diagnosed only in patients who underwent surgery (4.6%). The 5-year actuarial overall survival rates were 56.3% in the surgical group and 35.2% in the radiotherapy group (P = .007). Age involvement of pyriform sinus, N stage, and history of tracheostomy were independent prognostic factors for risk of death.

CONCLUSIONS

The presence of metastatic lymph nodes, age, and involvement of the pyriform sinus were the important prognostic factors in patients who underwent surgery. A small group of patients with T3,N0,M0 tumors could benefit from radiotherapy, with surgery reserved for recurrence.