Radiological tumor thickness as a risk factor for local recurrence in early glottic cancer treated with laser cordectomy

• Published in: European archives of oto-rhino-laryngology Vol. 275; no. 1; pp. 153 - 160
• Main Authors: Son, Ho-Jin, Lee, Yoon Se, Ku, Ja Yoon, Roh, Jong-Lyel, Choi, Seung-Ho, Nam, Soon Yuhl, Kim, Sang Yoon
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 2018
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - surgery; Female; Follow-Up Studies; Glottis - diagnostic imaging; Glottis - pathology; Glottis - surgery; Head and Neck Surgery; Humans; Laryngeal Neoplasms - diagnostic imaging; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - surgery; Laryngology; Laser Therapy; Male; Medicine; Medicine & Public Health; Microsurgery; Middle Aged; Neoplasm Recurrence, Local - diagnosis; Neoplasm Recurrence, Local - etiology; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neurosurgery; Otorhinolaryngology; Prognosis; Retrospective Studies; Risk Factors; Survival Analysis; Survival Rate; Tomography, X-Ray Computed; Recurrence; CT; Depth of invasion; Laser; Early glottic cancer; Cordectomy
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-017-4793-3

Objectives Despite the excellent prognosis of early glottic cancer (T1–T2), the significance of preoperatively measured tumor thickness has not been elucidated. We evaluated the role of tumor thickness measured using computed tomography (CT) as a predictive factor for recurrence of early glottic cancer after transoral laser microsurgery (TLM). Methods The medical records of 134 patients who were diagnosed with early glottic squamous cell carcinoma and underwent TLM were reviewed. Age, sex, clinical stage, preoperative biopsy, anterior commissure involvement, CT findings, recurrence, and overall survival were evaluated. Results Seventy-three patients (54 T1a, 2 T1b, and 17 T2) were enrolled. Tumor thickness on pathology increased proportionally with increased tumor thickness on CT. The recurrence-free survival (RFS) and overall survival rates were 82.2 and 91.2%, respectively. Upon univariate analysis, RFS was affected by the type of cordectomy, tumor differentiation, margin involvement, anterior commissure involvement, impaired vocal fold mobility, and tumor thickness (> 4 mm) on CT scan (all p  < 0.01). Among the relevant covariates, an involved or close resection margin [hazard ratio (HR) 19.2; 95% confidence interval (CI) 3.5–105.6; p  < 0.01], impaired vocal cord mobility (HR 8.5; 95% CI 1.45–49.2; p  = 0.02), and pathological tumor thickness (> 4 mm) (HR 6.0; p  = 0.02) were predictive of RFS. Conclusion Tumor thickness may be another predictive factor for recurrence in early glottic cancer. Before TLM, reviewing the extent of tumor thickness will help to improve local control in cases of early glottic cancer.