Significado pronóstico de las metástasis cervicales en tumores avanzados de laringe e hipofaringe / Prognostic significance of nodal metastasis in advanced tumors of the larynx and hypopharynx

Objetivos: Valorar la relevancia de la estadificación pN posquirúgica de los ganglios cervicales en la supervivencia global de los pacientes con tumores avanzados de laringe e hipofaringe, primariamente tratados con cirugía, incluyendo disección cervical (DC). Entender el significado pronóstico de la extensión extracapsular (EEC) de los ganglios linfáticos metastásicos y su impacto en la supervivencia. Material y métodos: Se realizó un estudio retrospectivo de pacientes primariamente sometidos a una laringectomía total (LT) con DC bilateral electiva o terapéutica. Se analizaron las supervivencias global y libre de la enfermedad, de acuerdo con los resultados histopatológicos posquirúrgicos de la DC, concernientes a la presencia o no de la afectación ganglionar, número de ganglios afectados, y existencia de EEC. Resultados: Ciento veinte pacientes cumplieron los criterios de inclusión del presente estudio. En cuanto a la afectación ganglionar, la evaluación histopatológica demostró positividad en el 46,6% de los pacientes cN0.La tasa de pacientes vivos a los 2 años de seguimiento, basada en el análisis pN, fue del 88,1% para el grupo pN0, del 65,4% para el grupo N+ sin EEC, del 46,2% para el grupo N+ con EEC en un ganglio, y del 15,4% para el grupo N+ con EEC en más de un ganglio (p<0,001). Conclusiones: Este estudio demuestra una alta prevalencia de la enfermedad oculta en el cuello, en tumores de laringe e hipofaringe. La afectación metastásica de ganglios linfáticos tiene un impacto negativo en la supervivencia. Los pacientes con EEC multinodal tienen una peor supervivencia, lo cual se reflejó en una mayor tasa de metástasis locorregionales y a distancia, en comparación a los casos de EEC que afecta a un único ganglio linfático(AU)

Objectives: To estimate the relevance of post-surgical neck nodal classification (pN) on the global survival of patients with advanced tumors of the larynx and hypopharynx, primarily treated with surgery including neck dissection (ND). To understand the prognostic significance of metastatic lymph nodes’ extracapsular spread (ECS) and its impact on survival. Material and methods: A retrospective review of patients primarily submitted for total laryngectomy (TL) with either elective or therapeutic bilateral ND. Overall and disease-free survival was analysed according to post-operative histopathological ND results, concerning the presence or absence of nodal involvement, number of affected nodes and the existence of ECS. Results: One hundred and twenty patients met the inclusion criteria of this study. Concerning nodal involvement, the histopathological evaluation demonstrated positive lymph nodes in 46.6% of the cN0 patients. The rate of patients alive after 2 years of follow-up, based on pN analysis, was 88.1% for the pN0 group, 65.4% for the group N+ without ECS, 46.2% for the N+ ECS+ (1 node) and 15.4% for the N+ ECS+ (more than 1 node) group (P<0.001). Conclusions: This study demonstrates a high prevalence of occult neck disease in tumours of the larynx and hypopharynx. The involvement of metastatic cervical lymph nodes has a negative impact on survival. Patients with multinodal ECS have a poorer survival, reflected by a higher rate of loco-regional and distant metastases, when compared to ECS in one single lymph node(AU)

Prognostic significance of nodal metastasis in advanced tumors of the larynx and hypopharynx.

OBJECTIVES: To estimate the relevance of post-surgical neck nodal classification (pN) on the global survival of patients with advanced tumors of the larynx and hypopharynx, primarily treated with surgery including neck dissection (ND). To understand the prognostic significance of metastatic lymph nodes' extracapsular spread (ECS) and its impact on survival. MATERIAL AND METHODS: A retrospective review of patients primarily submitted for total laryngectomy (TL) with either elective or therapeutic bilateral ND. Overall and disease-free survival was analysed according to post-operative histopathological ND results, concerning the presence or absence of nodal involvement, number of affected nodes and the existence of ECS. RESULTS: One hundred and twenty patients met the inclusion criteria of this study. Concerning nodal involvement, the histopathological evaluation demonstrated positive lymph nodes in 46.6% of the cN0 patients. The rate of patients alive after 2 years of follow-up, based on pN analysis, was 88.1% for the pN0 group, 65.4% for the group N+ without ECS, 46.2% for the N+ ECS+ (1 node) and 15.4% for the N+ ECS+ (more than 1 node) group (P<.001). CONCLUSIONS: This study demonstrates a high prevalence of occult neck disease in tumours of the larynx and hypopharynx. The involvement of metastatic cervical lymph nodes has a negative impact on survival. Patients with multinodal ECS have a poorer survival, reflected by a higher rate of loco-regional and distant metastases, when compared to ECS in one single lymph node.