Prognostic factors in laryngeal carcinoma. Experience in 296 male patients.

BACKGROUND: Laryngeal cancer is the primary cause of death among patients with head and neck cancer in Argentina. Different prognostic factors have been incidentally dealt with in a number of articles, but there are few studies of prognostic variables, such as age, tobacco, and alcohol, using multifactorial analysis. METHODS: Between 1969-1987, 296 male patients with epidermoid carcinoma of the larynx treated at the Institute of Oncology "Angel H. Roffo" were studied regarding prognostic factors of survival. The effect of age, tobacco, alcohol, histologic grade, extent of primary tumor, and cord mobility on survival were assessed by means of the Cox proportional-hazards model. RESULTS: The univariate analysis showed that primary tumor extent, nodal involvement, stage, alcohol intake, previous tracheostomy, and cord mobility were statistically significant predictors of survival. Multivariate analysis disclosed only nodal involvement, alcohol intake, and cord mobility as statistically significant variables in regard to survivorship. With these variables, a hazard index was calculated for each patient, and four risk groups were formed. Five-year survival rates were as follows: Group A, 79%; B, 69%; C, 47%; and D, 14% (A versus C, P < 0.005; A versus D, P < 0.005). CONCLUSIONS: This study confirmed the prognostic impact of nodal involvement and also showed the importance of cord fixation and alcohol drinking as predictors of survival.

Scanning electron microscopy of human submandibular gland.

The fracture surface of human submandibular gland analyzed by scanning electron microscopy is studied here. Acini showed spherical granules of 0.7 +/- 0.28 micron diameter, their most distinctive feature. Some empty, septate cavities found contiguous to serous acini were considered to be mucous acini. Striated ducts had a circular lumen, with microvilli forming prominences. Blebs, some intact and others ruptured, were interpreted as apocrine secretion. The 'separating zone' of the striated cells was distinguishable from the rest of the cell because the structure of the cell was granular whereas the 'separating zone' was fibrillar.

Fibromuscular dysplasia of the distal cervical internal carotid artery.

Fibromuscular dysplasia of the internal carotid artery is the most frequent extracranial localization of the disease. It can produce TIA or cerebral infarct through formation of fibrinous thrombi or complete occlusion of the artery. Seven cases are presented with disease localized in the distal segment of the carotid artery, usually considered inaccessible through standard exposure. A surgical approach is described to treat these lesions by performing a mandible osteotomy. This allows a resection of the internal carotid and its replacement with autologous saphenous vein graft as performed in six cases. The distal anastomosis was performed 1 or 2 cm. below the base of the skull. One case could not be corrected due to disease extending into the skull. All patients were operated on for TIA and one had a cerebral infarct. Six patients had an uneventful recovery and no further neurological symptoms. One patient had a postoperative hemiplegia. Pathologic specimens were described as fibromuscular dysplasia in all cases. Three of them had also a dissecting aneurysm, two of these also showed a ruptured intima. Intraluminal dilatation is regarded as a potentially risky procedure; resection and replacement through a mandible osteotomy is recommended for very distal internal carotid lesions.

Levamisole in squamous cell carcinoma of the head and neck.

One hundred and thirty-four patients (118 males and 16 females) with epidermoid carcinoma of the head and neck were studied. After treatment of the primary lesion, they were randomized into two groups: 69 received levamisole, 150 mg/day orally for 3 consecutive days every other week, and 65 received placebo. Immune status was also evaluated. Positive reactions to dinitrochlorobenzene increased significantly after primary tumor therapy in both levamisole- and placebo-treated patients. There were no significant differences in immune responses between the two groups, except in recall antigen reactivity, which was decreased in both groups overall recurrence and death rates at 36 months did not differ between the two groups of patients. However, stage I and II patients treated with levamisole had a significantly higher incidence of recurrence than the placebo-treated patients (P less than 0.02), while there was some evidence that levamisole-treated stage IV patients did better. It is concluded that the overall outcome in patients with squamous cell carcinoma controlled locally by surgery or radiation was not favorably affected by levamisole in the dose and schedule used in this protocol.

Cell-mediated immune response in head and neck cancer patients.

The immune reactivity of 100 head and neck cancer patients was studied by means of DNCB, candidine, blastic transformation with PHA, and lymphocyte counts. DNCB reactivity was strong in only 21% of the population and was found impaired in patients with advanced primitive tumors, with more than one primitive tumor, and in patients after radiation. Candidine reactivity was impaired in bigger primitive tumors, positive nodes, and advanced stages, as well as in postradiation patients. Blastic transformation was significantly worse in patients over 70 years and tended to be lower in patients with more than one primitive tumor. Good blastic transformation was also lowered in postradiation patients.