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Allegra E, Bianco MR, Modica DM, Azzolina A, Privitera E, Latella D, Occhiuzzi F, Galfano M, Saita V. Multicentric Study on Oncological Outcomes and Prognostic Factors of Open Partial Horizontal Laryngectomies. EAR, NOSE & THROAT JOURNAL 2024:1455613231225906. [PMID: 38321705 DOI: 10.1177/01455613231225906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Objective: In recent years, the number of open preservation surgeries for the treatment of laryngeal Cancer has increased. This surgery aims to maintain laryngeal function and ensure oncological radicality, thereby avoiding a total laryngectomy (TL) that could significantly impact the patient's quality of life. The purpose of this study was to assess the oncologic results of OPHL I and II and to identify prognostic factors that could impact patient survival and local failure rates. Methods: This study was conducted on 182 patients with laryngeal squamous cell carcinoma treated with OPHLs between 2005 and 2015. The survival rates of a group of patients treated with TL between 2004 and 2014 were taken into consideration to compare survival outcomes. Results: The disease-specific survival in pT2 and pT3 tumors in relation to the type of surgery showed no statistically significant difference between OPHLs and TL (P = .54 and P = .63, respectively). The 5-year T-recurrence-free survival showed that pT4 tumors, perineural/vascular positive invasion, and OPHL IIb + ARY-treated tumors were associated with a higher risk of tumor recurrence (P < .0001, P = .0005 and P = .016 respectively). Conclusions: OPHLs represent an excellent alternative to TL considering the characteristics of the tumor and the general conditions of the patient.
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Affiliation(s)
- Eugenia Allegra
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Maria Rita Bianco
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | - Alfio Azzolina
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
| | - Elio Privitera
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
| | - Daniele Latella
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | - Mario Galfano
- Otolaryngology Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Vincenzo Saita
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
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Igissin N, Zatonskikh V, Telmanova Z, Tulebaev R, Moore M. Laryngeal Cancer: Epidemiology, Etiology, and Prevention: A Narrative Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2023; 52:2248-2259. [PMID: 38106821 PMCID: PMC10719707 DOI: 10.18502/ijph.v52i11.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/18/2023] [Indexed: 12/19/2023]
Abstract
Laryngeal cancer comprises 30%-40% of head and neck malignancies, and it is the most common malignancy in otolaryngology. The main risk factors for laryngeal cancer are tobacco use, excessive alcohol consumption, gastroesophageal reflex, Plummer-Vinson syndrome, exposure to heat, chemicals, and some viral infections. This literature review summarizes all known data over the past decade with an assessment of the main etiological factors related to cancer incidence, general measurement issues in the cancer epidemiology and the current state of science in relation to laryngeal cancer. The geographical distribution of laryngeal cancer also reveals some important aspects. Europe remains the most prevalent continent for this type of malignancy, whilst the epidemiologic burden in Africa remains low. Overall, there are clear differences in morbidity and mortality from laryngeal cancer between urban and rural areas, with gender inequalities. In some countries, the incidence rates are high in rural areas, and in some, such as in China, the urban population is more affected. High rates of laryngeal cancer are closely associated with both low average income and a high percentage of the population with lower-than-average education countries with higher Socio-demographic Index (SDI) have made greater improvements in the treatment of LC than countries with lower SDI. Epidemiological data on risk factors can provide valuable information for developing cancer prevention strategies.
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Affiliation(s)
- Nurbek Igissin
- Research Institute of Life and Health Sciences, Higher School of Medicine, Kokshetau University Named After Sh. Ualikhanov, Kokshetau, Kazakhstan
- Central Asian Institute for Medical Research, Astana, Kazakhstan
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan
| | - Vera Zatonskikh
- Central Asian Institute for Medical Research, Astana, Kazakhstan
| | - Zhansaya Telmanova
- Central Asian Institute for Medical Research, Astana, Kazakhstan
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan
| | | | - Malcolm Moore
- Asian Pacific Organization for Cancer Prevention, Bishkek, Kyrgyzstan
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Wu L, Wu QC. Experience of individualized nursing in patients with laryngeal squamous cell carcinoma combined with Helicobacter pylori infection after surgery. J Cancer Res Clin Oncol 2023; 149:6575-6582. [PMID: 36781505 DOI: 10.1007/s00432-023-04627-z] [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: 12/15/2022] [Accepted: 01/29/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To explore the effect of personalized nursing on the therapeutic effect on patients with laryngeal squamous cell carcinoma (LSCC) combined with Helicobacter pylori (HP) infection after surgery. METHODS This study enrolled 46 patients with LSCC as research subjects. The patients were divided into an experimental group and a control group using the random number table method. Routine nursing was provided in the control group, and individualized nursing intervention was conducted in the experimental group based on routine nursing. The incidence of adverse reactions (ARs) and the patients' nursing satisfaction were compared between the two groups. RESULTS Compared with the control group, the individualized nursing intervention reduced the incidence of ARs of esophageal reflux (P < 0.05) and improved nursing satisfaction (P < 0.05). CONCLUSION Individualized nursing intervention reduced the incidence of esophageal reflux ARs in patients with LSCC and HP infection after tracheotomy and improved both the therapeutic effect of the treatment and the satisfaction of the patients.
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Affiliation(s)
- Li Wu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Aviation Road, Jingzhou, 434000, Hubei, China
| | - Qing-Cui Wu
- Infectious Diseases Department, The First Affiliated Hospital of Yangtze University, Shashi District, 8 Aviation Road, Jingzhou, 434000, Hubei, China.
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Succo G, Bertolin A, Santos IC, Tascone M, Lionello M, Fantini M, de Freitas AS, Bertotto I, Sprio AE, Sanguineti G, Dias FL, Rizzotto G, Crosetti E. Partial Laryngectomy for pT4a Laryngeal Cancer: Outcomes and Limits in Selected Cases. Cancers (Basel) 2023; 15:2861. [PMID: 37345197 DOI: 10.3390/cancers15102861] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 06/23/2023] Open
Abstract
A large multi-institutional case series of laryngeal cancer (LC) T4a was carried out, including 134 cases treated with open partial horizontal laryngectomies (OPHL) +/- post-operative radiation therapy (PORT). The goal was to understand better whether OPHL can be included among the viable options in selected pT4a LC patients who refuse a standard approach, represented by total laryngectomy (TL) + PORT. All 134 patients underwent OPHL type I (supraglottic), II (supracricoid), or III (supratracheal), according to the European Laryngological Society Classification. Comparing clinical and pathological stages showed pT up-staging in 105 cases (78.4%) and pN up-staging in 19 patients (11.4%). Five-year data on overall survival, disease-specific survival, disease-free survival, freedom from laryngectomy, and laryngo-esophageal dysfunction-free survival (rate of patients surviving without a local recurrence or requiring total laryngectomy and without a feeding tube or a tracheostomy) were, respectively, 82.1%, 89.8%, 75.7%, 89.7%, and 78.3%. Overall, complications were observed in 22 cases (16.4%). Sequelae were observed in 28 patients (20.9%). No patients died during the postoperative period. This large series highlights the good onco-functional results of low-volume pT4a laryngeal tumors, with minimal or absent cartilage destruction, treated with OPHLs. The level of standardization of the indication for OPHL should allow consideration of OPHL as a valid therapeutic option in cases where the patient refuses total laryngectomy or non-surgical protocols with concomitant chemo-radiotherapy.
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Affiliation(s)
- Giovanni Succo
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
- Oncology Department, University of Turin, 10124 Torino, Italy
| | - Andy Bertolin
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | | | - Martina Tascone
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | - Marco Lionello
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | - Marco Fantini
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
| | | | - Ilaria Bertotto
- Radiology Service, Candiolo Cancer Institute FPO IRCCS, Candiolo, 10060 Turin, Italy
| | - Andrea Elio Sprio
- Department of Research, ASOMI College of Sciences, 2080 Marsa, Malta
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy
| | - Fernando Luiz Dias
- Brazilian National Cancer Institute, Rio de Janeiro 20230-130, RJ, Brazil
| | - Giuseppe Rizzotto
- Otorhinolaryngology Unit, Vittorio Veneto Hospital, AULSS2 Treviso, 31029 Vittorio Veneto, Italy
| | - Erika Crosetti
- Otorhinolaryngology Unit, San Giovanni Bosco Hospital, 10154 Turin, Italy
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Puzzo L, Bianco MR, Salvatorelli L, Tinnirello G, Occhiuzzi F, Latella D, Allegra E. CD44, PDL1, and ATG7 Expression in Laryngeal Squamous Cell Carcinomas with Tissue Microarray (TMA) Technique: Evaluation of the Potential Prognostic and Predictive Roles. Cancers (Basel) 2023; 15:cancers15092461. [PMID: 37173926 PMCID: PMC10177409 DOI: 10.3390/cancers15092461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/15/2023] Open
Abstract
We focus on the new prognostic and predictive factors CD44, PDL1, and ATG7 in our study of surgical samples of patients with laryngeal squamous cell carcinoma (LSCC) using tissue microarray (TMA). Thirty-nine previously untreated patients affected by laryngeal carcinoma who then underwent surgical treatment were considered in this retrospective study. All surgical specimens were sampled, embedded in paraffin blocks, and stained with hematoxylin and eosin. A representative sample of the tumor was chosen and transferred into a new block of paraffin, the recipient block, to perform immunohistochemical analysis with the primary antibodies anti-CD44, PD-L1, and ATG7. At follow-up, 5-year disease-free survival (DFS) for negative and positive tumors was determined as 85.71% and 36% for CD44, 60% and 33.33% for PDL1, and 58.06% and 37.50% for ATG7, respectively. Multivariate analysis revealed that CD44 expression is an independent predictive factor of low-grade tumors (p = 0.008), lymph node metastasis at the time of diagnosis, and AGT7 negativity. Thus, CD44 expression is a potential marker for more aggressive forms of laryngeal cancer.
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Affiliation(s)
- Lidia Puzzo
- Department "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Maria Rita Bianco
- Department of Medical and Surgical Sciences, Otolaryngology, University of Catanzaro, 88100 Catanzaro, Italy
| | - Lucia Salvatorelli
- Department "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Giordana Tinnirello
- Department "G.F. Ingrassia", Section of Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Federico Occhiuzzi
- Department of Health Science, Otolaryngology, University of Catanzaro, 88100 Catanzaro, Italy
| | - Daniele Latella
- Department of Health Science, Otolaryngology, University of Catanzaro, 88100 Catanzaro, Italy
| | - Eugenia Allegra
- Department of Health Science, Otolaryngology, University of Catanzaro, 88100 Catanzaro, Italy
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Bianco MR, Pricoco GO, Azzolina A, Drago GD, Saita V, Allegra E. Olfactory function in laryngectomised patients: tracheo-oesophageal versus oesophageal speech. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:20-25. [PMID: 36860146 PMCID: PMC9978304 DOI: 10.14639/0392-100x-n2253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/23/2022] [Indexed: 03/03/2023]
Abstract
Objective This study aimed to evaluate olfactory function in patients rehabilitated with oesophageal (ES) voice or tracheo-oesophageal (TES) prosthesis to further verify whether there were differences in smell alterations depending on voice rehabilitation modality. Methods A total of 40 patients who had undergone total laryngectomy participated in the study. Speech rehabilitation was achieved through TES in 20 patients (Group A) or ES in 20 patients (Group B). Olfactory function was evaluated using the Sniffin' Sticks test. Results At olfactory evaluation, in Group A, 4/20 patients (20%) were anosmic, whereas 16/20 patients (80%) were hyposmic; in Group B, 11/20 patients (55%) were anosmic whereas 9/20 patients (45%) were hyposmic. A significant difference (p = 0.04) was found at global objective evaluation. Conclusions The study shows that the rehabilitation with TES contributes to maintaining a functioning, albeit limited, sense of smell.
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Affiliation(s)
- Maria Rita Bianco
- Otolaryngology, Department of Health Science, University of Catanzaro, Italy,Correspondence Maria Rita Bianco Otolaryngology-Head and Neck Surgery, Department of Health Sciences, University Magna Graecia of Catanzaro, viale Europa, 88100 Germaneto (CZ), Italy E-mail:
| | | | - Alfio Azzolina
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
| | | | - Vincenzo Saita
- Otolaryngology Unit, Cannizzaro Hospital, Catania, Italy
| | - Eugenia Allegra
- Otolaryngology, Department of Health Science, University of Catanzaro, Italy
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Mesolella M, Evangelista A, Allosso S, Matano E, Motta G, Motta G. New Therapeutic Strategies in the Treatment of Stomal Recurrence After Total Laryngectomy: Role of Immunotherapy. EAR, NOSE & THROAT JOURNAL 2022:1455613221121237. [PMID: 36131507 DOI: 10.1177/01455613221121237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the incidence of stoma recurrence and the therapeutic strategy outcomes in relation to survival that have been adopted over the past few decades using a monoclonal antibody, specifically nivolumab. METHODS This study included a total of 487 patients diagnosed with laryngeal carcinoma undergoing either a laryngectomy or salvage surgery after conservative interventions at the ENT Unit of Federico II University in Naples, Italy, between 2011 and 2021. Following a minimum 2.5-year follow-up and a maximum 21-year follow-up, the results revealed that only 38 patients suffered a stomal recurrence. RESULTS Despite various adopted treatment strategies, the literature reports lower patient survival rates. Following a total laryngectomy, stomal recurrence represents a therapeutic management challenge due to a poor prognosis for nearly every treated case. According to the literature, in fact, despite a low incidence (ie, 0.8-31.3%), the overall mortality rate increases from 77% to 100% after three years. Nevertheless, introducing immunotherapy into cancer treatment has resulted in an observable revolution in the treatment of different types of cancers over the years. CONCLUSION In light of recorded data on survival following the use of the nivolumab, the case presented in this study allows a new perspective of successfully treating recurrences of squamous carcinoma of the head and neck.
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Affiliation(s)
- Massimo Mesolella
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, Naples, Italy
| | - Antonietta Evangelista
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, Naples, Italy
| | - Salvatore Allosso
- Unit of Otorhinolaryngology, Department of Neuroscience, Reproductive Sciences and Dentistry, University Federico II of Naples, Naples, Italy
| | - Elide Matano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giovanni Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, Napoli, Italy
| | - Gaetano Motta
- Unit of Otorhinolaryngology, University Luigi Vanvitelli, Napoli, Italy
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Shaikh N, Morrow V, Stokes C, Chung J, Fancy T, Turner MT, Stokes WA. Factors Associated With a Prolonged Diagnosis-to-Treatment Interval in Laryngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2022; 166:1092-1098. [PMID: 35380886 DOI: 10.1177/01945998221090115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Evaluate factors associated with treatment delays and their effect on survival in laryngeal squamous cell carcinoma. STUDY DESIGN Retrospective cohort study. SETTING National Cancer Database. METHODS Patients receiving primary radiation or surgery for laryngeal squamous cell carcinoma were included from 2004 to 2017. The primary outcomes were the diagnosis-to-treatment interval (DTI) and 5-year survival. Variables of prolonged DTI (>30 days) were assessed via logistic regression models. Survival was then assessed through Cox proportional hazards models. Candidate variables for both outcomes included age, sex, race, ethnicity, distance to treatment facility, insurance coverage, treatment facility type, TNM T stage, nodal status, and DTI (in models estimating survival). RESULTS An overall 136,203 patients with laryngeal cancer were identified, from which 51,747 remained after exclusions were applied: 18,499 received primary surgery and 33,248 received primary radiation. Being a member of a racial or ethnic minority, advanced age, female sex, ≥30 miles from treatment facility, lack of insurance, treatment at an academic cancer center, and primary radiation were associated with a prolonged DTI. However, in spite of a faster DTI, treatment at a community cancer center was independently associated with higher mortality (hazard ratio, 1.2; P < .0001). CONCLUSIONS Despite being associated with prolonged DTI, receiving treatment at a high-volume academic facility was associated with significantly improved survival. Our results indicate that improved referral pathways or outreach may help improve survival in laryngeal cancer, especially in high-risk populations.
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Affiliation(s)
- Noah Shaikh
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Vincent Morrow
- School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Cara Stokes
- Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Tanya Fancy
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Meghan T Turner
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - William A Stokes
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
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Liu J, Sun Q, Zhao J, Qin X, Gao T, Bai G, Chen G, Guo Z. Early death in supraglottic laryngeal squamous cell carcinoma: A population-based study. EAR, NOSE & THROAT JOURNAL 2022:1455613221078184. [PMID: 35171058 DOI: 10.1177/01455613221078184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Supraglottic laryngeal squamous cell carcinoma (LSCC) is the second most common type of laryngeal cancer with a poor prognosis. Current population-based estimates of the early death rate and associated factors for early death of supraglottic LSCC are lacking. The purpose of this study was to assess the early death rate and related factors for early death in patients with supraglottic LSCC. METHODS We identified 3733 adult patients diagnosed with supraglottic LSCC between 2010 and 2017 for whom the vital status at 3 months was known from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were staged according to the seventh edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system. The early death (survival time ≤ 3 months) rate was calculated. Univariate and multivariate logistic regression analyses were performed to identify the risk factors associated with the early death rate. RESULTS 313 (8.38%) of the 3733 patients died within 3 months of diagnosis of supraglottic LSCC. Of these, 225 patients died from cancer-specific causes. Multivariate logistic regression analyses confirmed that advanced age, male sex, advanced T stage, advanced N stage, advanced M stage, and not undergoing treatment (surgery, radiotherapy, and chemotherapy) had significant correlations with all-cause early death in supraglottic LSCC. In addition, advanced age, advanced T stage, advanced N stage, advanced M stage, and not undergoing treatment (surgery, radiotherapy, and chemotherapy) were significantly correlated with cancer specificity in supraglottic LSCC. CONCLUSION When a tumor is newly diagnosed, we should pay close attention to sex, age, unmarried status and AJCC TNM staging to quickly detect supraglottic LSCC patients with a tendency toward early death. These findings have implications for precise prognosis prediction and individualized and personalized patient counseling and therapy.
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Affiliation(s)
- Jian Liu
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
| | - Qing Sun
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
| | - Jing Zhao
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
| | - Xuemei Qin
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
| | - Tianle Gao
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
| | - Guangping Bai
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
| | - Guohui Chen
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
| | - Zhiqiang Guo
- Department of Otolaryngology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, P. R. China
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