Prognostic significance of soft tissue deposits in laryngeal carcinoma

Ozmen, Omer Afsin; Alpay, Melih; Saraydaroglu, Ozlem; Demir, Uygar Levent; Kasapoglu, Fikret; Coskun, Hamdi Hakan; Basut, Oguz Ibrahim

doi:10.1016/j.bjorl.2017.07.002

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Brazilian Journal of Otorhinolaryngology

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Original articles • Braz. j. otorhinolaryngol. 84 (5) • Sep-Oct 2018 • https://doi.org/10.1016/j.bjorl.2017.07.002 copy

Prognostic significance of soft tissue deposits in laryngeal carcinoma^☆ ☆ Please cite this article as: Ozmen OA, Alpay M, Saraydaroglu O, Demir UL, Kasapoglu F, Coskun HH, et al. Prognostic significance of soft tissue deposits in laryngeal carcinoma. Braz J Otorhinolaryngol. 2018;84:566-73.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

Soft tissue deposits is tumorous islands apart from lymph nodes and occasionally diagnosed in neck dissection specimens. Their importance has begun to be recognized, however, their value has not been investigated in laryngeal cancer as a single tumor site.

Objective:

To investigate the prognostic value of soft tissue deposits in patients with laryngeal carcinoma.

Methods:

Medical records of 194 patients with laryngeal carcinoma who were treated primarily by surgery and neck dissection were reviewed. Prognostic significance of soft tissue deposits was assessed along with other clinical and pathological findings. Recurrence rates, overall and disease-specific survival rates were examined.

Results:

The incidence of soft tissue deposits was found to be 7.2% in laryngeal carcinoma. N stage was more advanced in patients who had soft tissue deposits. Regional recurrence rate was higher and disease specific and overall survivals rates were significantly lower in patients with soft tissue deposits in univariate analysis. However, in multivariate analysis, soft tissue deposits were not found as an independent risk factor.

Conclusion:

In laryngeal carcinoma, soft tissue deposits was diagnosed in patients with more advanced neck disease and their significance was lesser than other factors including extranodal extension.

KEYWORDS
Laryngeal cancer; Soft tissue deposit; Cervical metastasis; Prognosis; Survival

	Soft tissue deposit		Total n (%)	p-Value
	Present n (%)	Absent n (%)
Sex				1
Male	14 (100)	175 (97.2)	189 (97.4)
Female	0 (0)	5 (2.8)	5 (2.6)
Smoking				1
Yes	12 (85.7)	157 (87.2)	169 (87.1)
No	2 (14.3)	23 (12.8)	25 (12.9)
Comorbid disease				1
Present	5 (35.7)	62 (34.4)	67 (34.5)
Absent	9 (64.3)	118 (65.6)	127 (65.5)
Preoperative tracheotomy				0.085
Yes	7 (50)	45 (25)	52 (26.8)
No	7 (50)	135 (75)	142 (73.2)
Histopathological type				0.546
Classical SCC	14 (100)	156 (86.7)	170 (87.6)
Basaloid SCC	0 (0)	18 (10)	18 (9.3)
Verrucous SCC	0 (0)	1 (0.6)	1 (0.5)
Papillary SCC	0 (0)	5 (2.8)	5 (2.6)
Differentiation				0.589
Well	1 (7.1)	23 (13.1)	24 (12.6)
Moderately	7 (50)	99 (56.2)	106 (55.8)
Poorly	6 (42.9)	54 (30.7)	60 (31.6)
Pathological stage				0.071
Stage 1	0 (0)	9 (5)	9 (4.6)
Stage 2	0 (0)	26 (14,4)	26 (13.4)
Stage 3	1 (7.1)	42 (23.3)	43 (22.2)
Stage 4	13 (92.9)	103 (57.2)	116 (59.8)
T stage (pathological)				0.593
T1	1 (7.1)	9 (5.0)	10 (5.2)
T2	1 (7.1)	37(20.6)	38 (19.6)
T3	4 (28.6)	51 (28.3)	55 (28.4)
T4	8 (57.1)	83 (46.1)	91 (46.9)
N stage (pathological)				<0.001
N0	0 (0)	109 (60.6)	109 (56.2)
N1	2 (14.3)	36 (20)	38 (19.6)
N2	10 (71.4)	33 (18.3)	43 (22.2)
N3	2 (14.3)	2 (1.1)	4 (2.1)
Surgical margin				1
Negative	14 (100)	176 (97.8)	190 (97.9)
Positive	0 (0)	4 (2.2)	4 (2.1)
Extracapsular spread				0.002
Present	6 (42.9)	19 (10.6)	25 (12.9)
Absent	8 (57.1)	161 (89.4)	169 (87.1)
Conglomerated lymh nodes				<0.001
Present	8 (57.1)	11(6.1)	19 (9.8)
Absent	6 (42.9)	169 (93.9)	175 (90.2)
Perineural invasion				0.003
Present	8 (57.1)	34 (19.3)	42 (22.1)
Absent	6 (42.9)	142 (80.7)	148 (77.9)
Lymphovascular invasion				<0.001
Present	5 (35.7)	8 (4.5)	13 (6.8)
Absent	9 (64.3)	168 (95.5)	177 (93.2)
Total	14 (7.2)	180 (92.8)	194 (100)

	Soft tissue deposit		Total n (%)	p-Value
	Present n (%)	Absent n (%)
Laryngectomy				0.399
Partial	4 (28.6)	72 (40)	76 (39.2)
Total	10 (71.4)	108 (60)	118 (60.8)
Neck dissection				<0.001
Selective	3 (21.4)	168 (93.3)	171 (88.1)
Comprehensive	11 (78.6)	12 (6.7)	23 (11.9)
Adjuvant treatment				0.204
Radiotherapy	6 (42.9)	75 (41.7)	81 (41.8)
Chemoradiotherapy	6 (42.9)	45 (25)	51 (26.3)
None	2 (14.3)	60 (33.3)	62 (32.0)
Total	14 (7.2)	180 (92.8)	194 (100)

	Soft tissue deposit		Total n (%)	p-Value
	Present n (%)	Absent n (%)
Local recurrence
Present	0 (0)	10 (5.5)	10 (5.2)	0.781
Absent	14 (100)	170 (94.4)	184 (94.8)
Regional recurrence
Present	4 (28.6)	12 (6.7)	16 (8.2)	0.018
Absent	10 (71.4)	168 (93.3)	178 (91.8)
Distant metastasis
Present	2 (14.3)	13 (7.2)	15 (7.7)	0.664
Absent	12 (85.7)	167 (92.8)	179 (92.3)
Second primary
Present	2 (14.3)	22 (12.2)	24 (12.4)	1
Absent	12 (85.7)	158 (87.8)	170 (87.6)
Total	14 (7.2)	180 (92.8)	194 (100)

	Disease specific survival rate (%)			Overall survival rate (%)
	2 years	5 years	p-Value	2 years	5 years	p-Value
Smoking						0.041
Yes	87.5	80.2	0.044	79.9	64.6
No	100	100		95.7	79.7
Comorbid disease						0.076
Absent	89.5	81	0.686	85.1	74.6
Present	88.4	85.6		76.2	57.1
Preoperative tracheotomy						0.67
Absent	90.5	84.5	0.206	84.1	71.5
Present	85.2	78.3		75.3	55.1
Tumor type						0.534
Classical	89.1	81.8	0.508	81.1	63.3
Basaloid	100	88.9		87.7	78.0
Papillary	100	100		82.4	66.7
Differentiation						0.955
Well	90.9	83.3	0.894	83.1	65.3
Moderate	89.0	80.5		81.9	60.7
Poor	91.8	85.8		78.2	67.1
Surgical margin						0.141
Negative	89.9	83.5	0.003	82.5	67.5
Positive	50	50		50	50
N stage						0.004
0	94.9	90.2	0.017	91.4	75.3
1	86	79.4		75.9	65.9
2	74.7	67.9		59.7	46.5
3	50	50		50	50
Soft tissue deposits						0.002
Present	74	49.4	0.041	78.6	16.4
Absent	90.3	84.8		84.3	71.2
Extracapsular spread						<0.001
Present	59.1	50.7	< 0.001	56.8	37.9
Absent	92.9	86.9		86.9	71.2
Conglomerated lymph nodes						0.025
Present	74.6	74.6	0.143	55.8	37.2
Absent	90.5	83.8		84.4	70.1
Perineural invasion						0.002
Present	82.7	72.3	0.105	67.6	45.5
Absent	90.5	84.9		85.2	71.9
Lymphovascular invasion						0.167
Present	92.3	76.9	0.848	75.2	53.7
Absent	88.6	82.9		82	67.7
Neck dissection type						<0.001
Selective	90.3	87.1	0.001	85.9	74.3
Comprehensive	78.5	37.2		51.1	12.1
Local recurrences						0.007
Present	50	40	<0.001	50	40
Absent	91.7	86		83.8	68.9
Regional recurrences						<0.001
Present	55	34.4	<0.001	55	24.1
Absent	92.7	88		84.5	71.8
Distant metastasis						<0.001
Present	51.4	27.4	<0.001	51.4	22.9
Absent	92.4	87.5		84.3	70.9

	Hazard ratio (95% CI)	p-Value
Disease specific survival
Extracapsular spread	3.470 (1.209-9.964)	0.021
Surgical margin	0.203 (0.043-0.965)	0.045
Overall survival
Smoking	4.447 (1.058-18.687)	0.042
Extracapsular spread	2.197 (0.974-4.957)	0.058
Perineural invasion	2.166 (1.129-4.153)	0.02

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:oaozmen@yahoo.com (O.A. Ozmen).

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Prognostic significance of soft tissue deposits in laryngeal carcinoma☆ ☆ Please cite this article as: Ozmen OA, Alpay M, Saraydaroglu O, Demir UL, Kasapoglu F, Coskun HH, et al. Prognostic significance of soft tissue deposits in laryngeal carcinoma. Braz J Otorhinolaryngol. 2018;84:566-73.

Abstract

Introduction:

Objective:

Methods:

Results:

Conclusion:

Prognostic significance of soft tissue deposits in laryngeal carcinoma^☆ ☆ Please cite this article as: Ozmen OA, Alpay M, Saraydaroglu O, Demir UL, Kasapoglu F, Coskun HH, et al. Prognostic significance of soft tissue deposits in laryngeal carcinoma. Braz J Otorhinolaryngol. 2018;84:566-73.