Prognostic significance of Vascular and Perineural invasion in cancer of the larynx

• Published in: American journal of otolaryngology Vol. 19; no. 2; pp. 83 - 88
• Main Authors: YILMAZ, T, HOSAL, A. S, GEDIKOGLU, G, ÖNERCI, M, GÜRSEL, B, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.03.1998
• Subjects: Adult; Aged; Biological and medical sciences; Blood Vessels - pathology; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Disease-Free Survival; Glottis; Humans; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - pathology; Lymphatic Metastasis; Medical sciences; Middle Aged; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Otorhinolaryngology. Stomatology; Peripheral Nerves - pathology; Prognosis; Tumors; Upper respiratory tract, upper alimentary tract, paranasal sinuses, salivary glands: diseases, semeiology; Human; Recurrence; Squamous cell carcinoma; Prognosis; Lymph node; Malignant tumor; Metastasis; Laryngectomy; Survival; Invasion; Pathology; Histopathology; Surgery; Blood vessel; ENT disease; Evolution; Larynx; Larynx disease; Predictive factor; Laryngeal nerve
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/S0196-0709(98)90100-4

Perineural and vascular invasion are generally recognized as poor prognostic factors in cancer. The authors report the prognostic significance of perineural and vascular invasion in cancer of the larynx. The laryngectomy specimens of 94 patients with squamous cell carcinoma of the larynx were analyzed histopathologically for vascular and perineural invasion. Prognostic significance of vascular and perineural invasion was evaluated related to the cervical lymph node metastasis, recurrence, and disease-free survival. Vascular invasion significantly influences cervical lymph node metastasis for supraglottic tumors, yet not for glottic and transglottic tumors. Perineural invasion has marginal significance in cases of cervical lymph node metastasis of supraglottic tumors; it has no significance in cases of cervical lymph node metastasis of glottic and transglottic tumors. Vascular invasion significantly increases local and regional recurrence rate, but not distant metastasis rate. Perineural invasion significantly increases local recurrence rate, but not regional recurrence and distant metastasis rate. The disease-free survival is significantly shortened by the presence of vascular and perineural invasion. According to multivariant analysis, neither vascular nor perineural invasion significantly effects the disease-free survival independently (P> .15). The presence of vascular invasion significantly affects the recurrence independently (P=.045). The presence of vascular invasion significantly reduces the interval between surgery and the development of recurrence (P=.013). The presence of vascular and perineural invasion should be checked in every laryngectomy specimen because both have a significant prognostic value; both influence the disease-free survival and recurrence significantly. Vascular invasion significantly increase cervical lymph node metastasis of supraglottic tumors; perineural invasion has only marginally significant effect on cervical lymph node metastasis of supraglottic cancers. Vascular invasion plays an independent role in determining the recurrence.