1
|
Ling Z, Hu G, Wang Z, Ma W, Wang X, Zhu J, Zeng Q. Prognostic analysis of surgical treatment for T3 glottic laryngeal cancer based on different tumor extension patterns. Eur Arch Otorhinolaryngol 2024; 281:1379-1389. [PMID: 38110749 DOI: 10.1007/s00405-023-08374-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND AND OBJECTIVES To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. METHODS We conducted a retrospective analysis of clinical data of 91 patients with T3 glottic laryngeal cancer. RESULTS We found that the posterior invasion being significantly associated with involvement of the lamina of cricoid cartilage (P < 0.001), arytenoid cartilage (P = 0.001), and subglottic (P = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy (TL) group and the partial laryngectomy (PL) group, but in the PL group, tumors with anterior invasion were associated with a better 5-year DFS than tumors with posterior invasion (HR: 4.681, 95% CI: 1.337-16.393, P = 0.016), and subglottic involvement was associated with worse LRRFS (HR: 3.931, 95% CI: 1.054-14.658, P = 0.041). At the same time, we found that involvement of the lamina of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in PL patients (HR: 11.67, 95% CI: 1.89-71.98, P = 0.008). CONCLUSION Selectively performed PL can also achieve favorable oncological outcomes comparable to those of TL. Posterior invasion and subglottic involvement are independent prognostic factors for recurrence after PL in T3 glottic laryngeal cancer, and involvement of the lamina of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of patients with laryngeal cancer should be further subdivided to allow for selection of a more individualized treatment plan.
Collapse
Affiliation(s)
- Zhiming Ling
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Guohua Hu
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zhihai Wang
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Wei Ma
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Xiaoqiang Wang
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Jiang Zhu
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Quan Zeng
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
| |
Collapse
|
2
|
凌 志, 胡 国, 王 志, 马 玮, 王 晓, 朱 江, 曾 泉. [Prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:998-1004. [PMID: 38114321 PMCID: PMC10985688 DOI: 10.13201/j.issn.2096-7993.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 12/21/2023]
Abstract
Objective:To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. Methods:A retrospective analysis was conducted on the clinical data of 91 patients with T3 glottic laryngeal cancer. Results:Among the 91 patients, 58 cases (63.7%) had anterior invasion and 33 cases (36.3%) had posterior invasion. The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage (P<0.001), arytenoid cartilage (P= 0.001), and subglottic region(P = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group. But in the partial laryngectomy group, the 5-year disease-free survival(DFS) of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors (HR: 4.681, 95%CI 1.337-16.393, P=0.016), and subglottic invasion was associated with worse loco-regional recurrence-free survival(LRRFS)(HR: 3.931, 95%CI 1.054-14.658, P=0.041). At the same time, we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients (HR:11.67, 95%CI 1.89-71.98,P=0.008). Conclusion:Compared with total laryngectomy, selected partial laryngectomy can also achieve favorable oncological outcomes. Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer, and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.
Collapse
Affiliation(s)
- 志明 凌
- 重庆医科大学附属第一医院耳鼻咽喉头颈外科(重庆,400016)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 国华 胡
- 重庆医科大学附属第一医院耳鼻咽喉头颈外科(重庆,400016)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 志海 王
- 重庆医科大学附属第一医院耳鼻咽喉头颈外科(重庆,400016)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 玮 马
- 重庆医科大学附属第一医院耳鼻咽喉头颈外科(重庆,400016)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 晓强 王
- 重庆医科大学附属第一医院耳鼻咽喉头颈外科(重庆,400016)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 江 朱
- 重庆医科大学附属第一医院耳鼻咽喉头颈外科(重庆,400016)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - 泉 曾
- 重庆医科大学附属第一医院耳鼻咽喉头颈外科(重庆,400016)Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| |
Collapse
|
3
|
Haas M, Lein A, Fuereder T, Schnoell J, Brkic FF, Campion NJ, Liu DT, Kadletz-Wanke L, Heiduschka G, Jank BJ. Low free triiodothyronine and immune-related hyperthyroidism are associated with overall and progression-free survival in head and neck squamous cell carcinoma treated with pembrolizumab. Int Immunopharmacol 2023; 123:110799. [PMID: 37598631 DOI: 10.1016/j.intimp.2023.110799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/22/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Thyroid function is frequently impaired in recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC). In patients treated with pembrolizumab, immune-related adverse events (irAEs) of the thyroid are common. However, the prognostic significance of baseline and on-treatment thyroid dysfunction is currently unclear. METHODS This study included 95 patients who received pembrolizumab for R/M HNSCC between 2016 and 2022. Baseline thyroid status, according to serum hormone levels, and irAEs were assessed. Univariable and multivariable Cox regression analyses were performed for overall survival (OS) and progression-free survival (PFS). Furthermore, the best overall response according to the prognostic groups was examined. RESULTS Low fT3 (HR: 2.52, p = 0.006), immune-related hyperthyroidism (HR: 0.11, p = 0.038), ECOG performance status ≥2 (HR: 3.72, p = 0.002), and platinum-refractory disease (HR: 3.29, p = 0.020) were independently associated with OS. Furthermore, immune-related hyperthyroidism was associated with longer PFS (HR: 0.13, p = 0.007), a higher objective response rate (83% vs. 31%, p = 0.018), and a higher disease control rate (100% vs. 43%, p = 0.008). Thyroid-related autoantibodies were elevated in 40% of thyroid irAEs cases with available measurements. Out of 16 thyroid irAEs, 15 occurred in patients with fT3 above the lower limit of normal. CONCLUSION Low fT3 was associated with worse OS. Immune-related hyperthyroidism was correlated with both improved OS and PFS. Baseline fT3 assessment and close on-treatment monitoring of serum thyroid levels may be valuable for risk stratification in R/M HNSCC patients receiving pembrolizumab.
Collapse
Affiliation(s)
- Markus Haas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Lein
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Thorsten Fuereder
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Julia Schnoell
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Faris F Brkic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Nicholas J Campion
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - David T Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kadletz-Wanke
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Gregor Heiduschka
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
| | - Bernhard J Jank
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
4
|
李 俊, 邱 轲, 任 建, 陈 飞, 刘 均. [Overview of thyroid gland involvement and its prognostic value on advanced laryngeal cancer]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:72-75;80. [PMID: 36597373 PMCID: PMC10128351 DOI: 10.13201/j.issn.2096-7993.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/11/2022] [Indexed: 01/05/2023]
Abstract
Laryngeal cancer is the second most common malignancy in the head and neck region. The guidelines recommend prophylactic thyroidectomy for patients with advanced laryngeal cancer, but its prognostic value remains elusive. In this review, the incidence, risk factors, prognostic value of thyroid invasion in patients with laryngeal cancer were reviewed. The effect of prophylactic thyroidectomy on the outcome of advanced laryngeal cancer patients was also discussed.
Collapse
Affiliation(s)
- 俊虹 李
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - 轲 邱
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - 建君 任
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - 飞 陈
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - 均 刘
- 四川大学华西医院耳鼻咽喉头颈外科(成都,610041)Department of Otolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China
| |
Collapse
|
5
|
Xie J, Wu P, Liu H, Zhang S, Lu Z. Thyroid gland invasion in total laryngectomy: A systematic review and meta-analysis. Int J Surg 2022; 99:106262. [PMID: 35172203 DOI: 10.1016/j.ijsu.2022.106262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although guidelines indicate that thyroidectomy should be performed routinely during total laryngectomy in patients with advanced laryngeal cancer, its clinical indications remain controversial. Some researchers believe that thyroid invasion is uncommon and that thyroid preservation should be considered in most cases. OBJECTIVE This study aimed to identify the incidence and predictors of thyroid invasion in patients with laryngeal cancer to facilitate decision-making regarding whether to perform thyroidectomy during total laryngectomy. MATERIALS AND METHODS The author conducted a systematic review and meta-analysis of all published articles retrieved from a search of the MEDLINE (1982-2020) and EMBASE (1971-2020) databases. The published studies of advanced laryngeal cancer with total laryngectomy and partial or total thyroidectomy for laryngeal cancer were selected. The incidence and predictors of thyroid invasion were analyzed. RESULTS We analyzed 25 studies (2177 cases), of which 176 people (8.08%) had thyroid invasion. Subglottic tumors (odds ratio [OR], 3.74; 95% CI, 1.75-7.99), T4 stage tumors (OR, 2.39; 95% CI, 1.20-4.75), subglottic extension (OR, 3.85; 95% CI,2.09-7.11), and thyroid cartilage invasion (OR, 3.98; 95% CI, 1.47-10.75) are risk factors for thyroid invasion, and no statistically significant difference was noted between recurrent tumor and thyroid invasion. CONCLUSION The risk of thyroid invasion was significantly higher when advanced laryngeal cancer involved subglottic tumors, T4 stage tumors, subglottic extension, and thyroid cartilage invasion. The overall incidence of thyroid gland invasion was low; therefore, thyroidectomy may be performed for cases deemed risky rather than as a routine measure of total laryngectomy. RESEARCH REGISTRY UIN: reviewregistry1226.
Collapse
Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China Shantou University Medical College, Shantou, Guangdong, China The Second School of Clinical Medicine, Southern Medical University, China
| | | | | | | | | |
Collapse
|
6
|
Pasha HA, Wasif M, Ikram M, Hammad M, Ghaloo SK, Rashid Z. Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension. Int Arch Otorhinolaryngol 2022; 26:e574-e578. [PMID: 36405478 PMCID: PMC9668439 DOI: 10.1055/s-0041-1740200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction
Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously.
Objective
To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained.
Methods
We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study.
Results
We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (
p
= 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI.
Conclusion
Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.
Collapse
Affiliation(s)
- Hamdan Ahmed Pasha
- Department of Otolaryngology and Head and Neck Surgery, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Muhammad Wasif
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mubasher Ikram
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Hammad
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shayan Khalid Ghaloo
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Zafar Rashid
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|