ABSTRACT
INTRODUCTION: The worldwide incidence rate of laryngeal cancer is declining. However, the 5-year survival for these patients has decreased in recent years from 66% to 63%. This may be due to changes in the treatment of the disease. The present study aimed to evaluate the survival rate of patients with LC according to the stage of the disease and the treatment applied. For this purpose, surgical versus organ preservation protocols (OPP) based on chemoradiotherapy were evaluated. METHODS: A retrospective cohort study was conducted in a tertiary hospital. The study included adult patients with a clinical diagnosis of primary LC. Patients with LC and systemic metastases and those with synchronous tumors at diagnosis were excluded. Univariate and multivariate analyses were performed to determine the association between exposure to LC treatment and the time to event (death). Overall survival (OS), cause-specific survival (CSS), and disease-free survival (DFS) were calculated. RESULTS: Patients with advanced tumors (stages III and IV) had almost three times the risk of LC death than those in the initial tumor stages (I and II) [HR CCS = 2.89 (95%CI 1.30-6.39)]; [HR OS = 2.01 (95%CI 1.35-2.98)]. Patients who underwent surgical treatment had a higher chance of survival than those who were treated according to OPP [HR = 0.62; 95%CI (0.38-1.02)] in CSS, 0.74 [95%CI (0.50-1.90)] in OS, and 0.61 [95%CI (0.40-0.91)] in DFS. DISCUSSION: OPP changed the management of patients with advanced stages of LC, establishing CRT as an alternative to surgery. Our data did not reveal clinically relevant differences in OS between patients treated with OPP and those who underwent surgery; however, we reported differences in the DFS rate after five years of follow-up in favor of the surgery-treated group of patients. CONCLUSION: Surgical treatment improves CSS and DFS at five years in patients with initial LC with respect to radiation therapy alone. Furthermore, surgical treatment associated with complementary radiation therapy offers better CSS and DFS in patients with advanced LC.
ABSTRACT
Objetivo. La clasificación histológica de la Organización Mundial de la Salud (OMS) junto con mejores estudios de imagen aportan información relevante para el manejo de los cánceres de parótida. Sin embargo, su pronóstico depende de otros factores diferentes de la histología y la extensión tumoral. El presente trabajo valora la utilidad de la clasificación pronóstica de Vander Poorten creada en 1999 de los cánceres parotídeos que incluye todos estos factores en los pacientes de nuestro medio. Métodos. Seguimiento de 19 pacientes con carcinomas de parótida distintos de tumores linfoideos o metástasis intraparotídeas entre los años 1998 y 2012. Se obtuvo su índice pronóstico a partir de las fórmulas propuestas por Vander Poorten, que incluyen los factores de edad, tamaño tumoral, afectación ganglionar, invasión cutánea, afectación del nervio facial, crecimiento perineural y márgenes de resección, antes de la cirugía (PS1) y después (PS2). Se relacionó la supervivencia global a los 5 años de cada paciente a partir de su inclusión en alguno de los 4 grupos de riesgo definidos. Resultados. La estratificación de riesgo de Vander Poorten según los resultados PS2 se distribuyó en grupos de riesgo (GR) 1 (3 pacientes, 15,7%), 2 (5 pacientes, 26,3%), 3 (un paciente, 5,8%) y 4 (10 pacientes, 52,2%). Los 6 pacientes que fallecieron durante el seguimiento pertenecían al GR4. De los 4 supervivientes del GR4 solo uno ha superado el seguimiento de 5 años. La comparación de las medias que relacionan las variables de resultado pretratamiento (PS1) y postratamiento (PS2) mostró una mejor supervivencia global en los pacientes con valores de PS1 < 4,5 y PS2 < 4,9, mientras que la mortalidad fue mayor a partir de los índices de PS1 > 6,5 y PS2 > 7,7. Conclusiones. El índice de Vander Poorten es aplicable en áreas hospitalarias con escaso número de carcinomas de parótida. Permite establecer un pronóstico de supervivencia más certero sobre pacientes individuales (AU)
Objective. The histological classification of the World Health Organization (WHO), along with improved imaging studies, provide relevant information for the management of parotid carcinomas. However, the prognosis depends on factors other than histology and tumor extension. This article evaluates the usefulness of a prognostic classification of parotid cancers, including these factors in patients in a hospital area. Methods. A follow-up was conducted on 19 patients with parotid carcinomas, excluding lymphoid tumors or intra-parotid metastases, between 1998 and 2012. The prognostic index was obtained from the formulas proposed by Vander Poorten, with factors including age, tumor size, lymph node involvement, skin invasion, facial nerve involvement, perineural growth and margins of resection, before surgery (PS1) and after (PS2). Overall survival was related to 5 years for each patient based on their inclusion in any of the 4 risk groups defined. Results. Risk stratification based on the results Vander Poorten PS2 was distributed into Risk Groups (GR) 1 (3 patients, 15.7%), 2 (5 patients, 26.3%), 3 (1 patient, 5.8%) and 4 (10 patients, 52.2%). The 6 patients who died during follow-up belonged to GR4. Only one of the 4 patients belonging to GR4 has exceeded the 5-year survival up to the current time. The comparison of the values that relate the pretreatment (PS1) and after treatment (PS2) results showed overall survival in patients with PS1 < 4.5 and PS2 < 4.9, whereas mortality was greater with indices of PS1 > 6.5 and PS2 > 7.7. Conclusions. Vander Poorten index can be applied in hospital areas with small numbers of parotid carcinomas. It enables a more accurate prognosis for individual patients (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Parotid Neoplasms/classification , Parotid Neoplasms/epidemiology , Parotid Neoplasms/physiopathology , Prognosis , Carcinoma/complications , Carcinoma/diagnosis , Carcinoma/epidemiology , Salivary Gland Neoplasms/classification , Injury Severity Score , Neoplasm Staging/classification , Neoplasm Staging/methods , Retrospective Studies , 28599 , Risk GroupsABSTRACT
El Carcinoma fusocelular de laringe, es una variante infrecuente del carcinoma de células escamosas, que forma parte de los tumores de vías aero-digestivas superiores con estirpe histológica mixta. Su asociación con el carcinoma verrucoso en el mismo espécimen quirúrgico es excepcional. Presentamos el caso de un paciente portador de esta duplicidad neoplásica, y aprovechamos para revisar el concepto y su dificultad diagnóstica, así como su tratamiento y evolución, que están supeditados al de la variante histológica de mayor agresividad.Palabras clave: Carcinoma fusocelular. Carcinoma verrucoso. Laringe.
