RESUMEN
OBJECTIVE: To determine whether early development of carcinoma in young patients could be explained by an alternative pathway such as microsatellite instability or whether it follows the classical tumor suppressor pathway characterized by loss of heterozygosity. STUDY DESIGN: Microsatellite instability, loss of heterozygosity, and multiple mismatch repair, p16, p53, and p63 protein expression were analyzed in a series of 18 young patients with laryngeal cancer. RESULTS: Only 2 of the 18 cases showed low microsatellite instability, whereas 9 of 17 presented loss of heterozygosity in at least one of the markers tested. All cases retained multiple mismatch repair protein expression. The p53, p16, and p63 expression profiles were consistent with the classical tumor suppressor pathway. CONCLUSION: Laryngeal carcinoma in young patients develops through the classical tumor suppressor pathway.
Asunto(s)
Neoplasias Laríngeas/genética , Inestabilidad de Microsatélites , Adulto , Reparación de la Incompatibilidad de ADN , Femenino , Genes Supresores de Tumor , Humanos , Pérdida de Heterocigocidad , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: To evaluate the outcomes of transoral laser microsurgery (TLM) in the treatment of T2 to T3 laryngeal carcinomas growing in the laryngeal anterior commissure. METHODS: This study was a retrospective analysis of 107 patients. Overall survival, disease-specific survival, and laryngectomy-free survival were analyzed. Technical difficulties, postoperative complications, influence of the learning curve, and the number of surgeries were evaluated. RESULTS: Five-year overall survival, disease-specific survival, and laryngectomy-free survival were 71%, 79.5%, and 71.4%, respectively. The probability of tumor relapse was related to the status of the margins (p = .01) and to surgical experience (p = .02), but not to tumor exposure (p = .78) or pT category (p = .36). Disease-specific survival differed significantly between the group of patients treated in the early period of surgical experience and those treated in the advanced period of surgical experience (71% vs 94%; p = .02) CONCLUSION: TLM is a useful treatment for T2 to T3 laryngeal carcinomas growing in the laryngeal anterior commissure when it is performed under an advanced learning curve.
Asunto(s)
Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/cirugía , Neoplasias Laríngeas/mortalidad , Neoplasias Laríngeas/cirugía , Terapia por Láser , Microcirugia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Células Escamosas/patología , Competencia Clínica , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Laríngeas/patología , Laringectomía , Láseres de Gas , Masculino , Persona de Mediana Edad , Disección del Cuello , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Calidad de la VozRESUMEN
BACKGROUND: Transoral CO(2) laser microsurgery (TLM) resection of laryngeal-hypopharyngeal squamous cell carcinomas has become a standard procedure. The objective was to evaluate whether there is a relationship between TLM and a higher incidence of distant metastases. METHODS: We conducted a retrospective analysis of 340 consecutive patients with laryngeal or hypopharyngeal squamous cell carcinoma treated with TLM. RESULTS: Distant metastases occurred in 24 of 340 (7.1%) patients. The mean time of distant metastases diagnosis was 19.1 months (range, 1-41) postsurgery. Univariate study demonstrated an association with alcoholism (p = .008), tumor site (p<.001), grade of differentiation (p = .032), stage (p<.001), tumor classification (T; p = .001), node involvement (N; p<.001), extracapsular node spread (p<.001), and positive surgical margin (p = .004). In multivariate logistic regression analysis, location (sinus piriform: OR = 15.37, p = .025), node involvement (N2: OR = 7.36, p = .003; N3: OR = 19.28, p = .027), and the affected surgical margin (OR 5.32; p = .005) predicted an increased likelihood of distant metastases. CONCLUSIONS: Development of distant metastases after TLM in patients with squamous cell carcinoma depends mainly on the tumor site, the presence of metastatic lymph node disease, and the margin status after resection.
Asunto(s)
Carcinoma de Células Escamosas/secundario , Neoplasias Hipofaríngeas/patología , Neoplasias Laríngeas/patología , Terapia por Láser/efectos adversos , Microcirugia , Adulto , Anciano , Carcinoma de Células Escamosas/cirugía , Femenino , Humanos , Neoplasias Hipofaríngeas/cirugía , Neoplasias Laríngeas/cirugía , Terapia por Láser/métodos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Transoral CO2 laser surgery (TLS) has demonstrated good oncologic results and low morbidity in the treatment of selected laryngeal carcinomas, but experience in hypopharyngeal carcinomas (HC) is limited. The aim of this study was to evaluate the usefulness of TLS in the treatment of selected HC. METHODS: Twenty-eight patients with HC were treated with TLS and neck dissection. Tumors with preoperative invasion of thyroid cartilage at CT, deep growth into the cervical space or tongue base, and tumors crossing the posterior midline or involving the cervical esophagus were excluded. Postoperative radiation to the neck was administered when more than one lymph node was involved, when the metastasis diameter was greater than 2 cm, or when extranodal spread was found at the pathologic study. RESULTS: The sample included two T1, 16 T2, nine T3, and one T4 tumors. Stage classification was: II, 21.4%; III, 28.6%; and IV, 50%. Four-year overall and disease-specific survival rates were 43.4% and 59.4%, respectively, with 78.5% function preservation. Nine patients (32.1%) did not need a nasogastric feeding tube. The mean duration of the feeding tube in the remaining patients was 15.27 +/- 27.3 days. We had two postoperative bleeding episodes that required endoscopic coagulation and three postoperative pneumonias caused by aspiration. CONCLUSIONS: TLS is an alternative for the treatment of selected HC associated with a high larynx preservation rate.