RESUMEN
Symptoms of 301 patients with laryngeal squamous cell carcinoma were evaluated. Tumour site affected the symptom profile significantly. Hoarseness was more common among patients with glottic and subglottic tumours, but was also the leading symptom in supraglottic patients. Other symptoms were mainly associated with supraglottic tumours and more advanced glottic lesions. There was a positive correlation between the number of symptoms and stage, regardless of tumour site. Patients with a supraglottic tumour had significantly more symptoms (median 2) than those with a glottic lesion (median 1). The median duration of the symptoms was significantly longer in stages III-IV (4.7 months) than in stages I-II (3.8 months). In the multivariate analysis, tumour stage was the only variable showing prognostic significance.
Asunto(s)
Carcinoma de Células Escamosas/patología , Ronquera/etiología , Neoplasias Laríngeas/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , Pronóstico , Factores de TiempoRESUMEN
OBJECTIVE: To evaluate radiotherapy outcome and prognostic factors in early glottic carcinoma. METHODS: The medical records of 76 patients with glottic T1N0 or T2N0 squamous cell carcinoma diagnosed at Tampere University Hospital from 1970 to 1991 and treated with primary radiotherapy were retrospectively reviewed. Except for three patients treated during the last years of the study period, radiotherapy was delivered by split-course technique with a pause of 1-3 weeks in the middle of the treatment. Primary locoregional control and disease-specific survival were analysed by the Kaplan-Meier method, and the log rank test was applied to compare the survival functions. Prognostic factors were evaluated by uni- and multivariate Cox regression analysis. RESULTS: The 10-year locoregional control rate after radiotherapy was 83 and 48% for patients with T1 and T2 tumours, respectively (P = 0.0005). The 10-year disease-specific survival was 91% for T1 and 69% for T2 disease (P = 0.0018). The larynx could be preserved in 87% of T1 and 44% of T2 cases. Tumour extent expressed by the number of vocal cord thirds involved was the only factor with significant prognostic value in the multivariate analysis of primary locoregional control (hazard ratio (HR) 3.2, 95%CI 1.8-5.8, P = 0.0001). Involvement of the posterior vocal cord third (HR 8.4, 95%CI 1.0-69.5, P = 0.04899) and T-category (HR 3.0, 95% CI 0.9-10.2, P = 0.0790) were connected with poorer prognosis in the multivariate analysis of disease-specific survival. In the multivariate analysis of T1 cases only, higher number of vocal cord thirds involved (HR 5.9, 95%CI 2.2 16.2, P = 0.0005) and longer treatment duration (HR 1.1, 95%CI 1.0-1.3, P = 0.0188) indicated worse locoregional control. Treatment duration (HR 1.2, 95%CI 1.0-1.3, P = 0.0384) together with posterior cord involvement (HR 9.9, 95% CI 1.1-92.7, P= 0.0437) signified poorer survival. CONCLUSION: Our findings indicate that the extent of the tumour is the most important predictor of radiotherapy outcome in early glottic carcinoma. This suggests that a classification based on the actual size of the tumour could be a better prognostic indicator than the conventional T-grouping. Although treatment duration was significant only in separate analysis of T1 cases, the split-course regimen resulting in long treatment times may be considered a major contributor to our relatively low local control rate also in T2 disease.
Asunto(s)
Carcinoma/radioterapia , Glotis , Neoplasias Laríngeas/radioterapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/fisiopatología , Carcinoma/cirugía , Femenino , Humanos , Neoplasias Laríngeas/fisiopatología , Neoplasias Laríngeas/cirugía , Laringectomía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/cirugía , Pronóstico , Traumatismos por Radiación , Análisis de Supervivencia , Resultado del Tratamiento , Pliegues Vocales/fisiopatología , Pliegues Vocales/cirugíaRESUMEN
Cancer of the larynx represents worldwide approximately 1-2% of all cancers and generally occurs predominantly in males. Based upon many reports, the age-adjusted incidence of laryngeal cancer has been rising in recent years, especially among women. Squamous cell carcinomas arising in the glottic region are the most common of all laryngeal cancers and more prevalent than the supraglottic ones. Subglottic disease is still rare. The Finnish Head and Neck Oncology Group evaluated the present occurrence of laryngeal cancer by site and gender in Finland. The annual age-standardized incidence of laryngeal cancer is 3.2 per 100,000 for men and 0.3 per 100,000 for women. The proportion of females in the five university centers reviewed was 5%. During the 30-year time period from the early 1960s to the 1990s there has been a significant decrease in the laryngeal cancer incidence rates for males, but no change for females. Finland thus seems to be the only Western country with clearly declining occurrence rates in recent decades. In the same time period a clear decrease in the incidence of bronchial cancer has occurred in males and an increase in females. The results also show that in all five university hospital districts glottic cancer became more common (50-68%) in the late 1980s and 1990s, which is opposite to the situation in the 1960s when supraglottic localizations (65%) dominated in Finland.
Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Neoplasias Laríngeas/epidemiología , Adulto , Anciano , Carcinoma de Células Escamosas/etiología , Estudios Transversales , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Neoplasias Laríngeas/etiología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores SexualesRESUMEN
In order to evaluate differences in epidemiology, clinical characteristics and prognosis, 166 glottic and 127 supraglottic cases of laryngeal squamous cell carcinoma diagnosed between 1962 and 1991 at Tampere University Hospital, Finland, were reviewed. The annual age-adjusted incidence in males decreased from 6.7/100,000 to 2.6/100,000 and the proportion of glottic tumours increased from one-third to two-thirds during the study period. The proportion of early stage lesions was greater among glottic tumours, and patients with a supraglottic tumour presented more often with neck node metastases. Hoarseness was the most common symptom, being more prevalent in patients with a glottic tumour. The symptom pattern of supraglottic carcinoma was altogether more diffuse. The 5-year disease-specific survival was 81% in glottic and 70% in supraglottic disease, but the difference in survival was not statistically significant. In the multivariate Cox regression analysis, higher T-category and presence of neck node metastases had adverse prognostic effect, while location of the tumour did not significantly affect the prognosis. Favourable changes in smoking habits seem to be the main reason for the incidence decrease and obviously also for the decrease in the proportion of supraglottic tumours.
Asunto(s)
Carcinoma de Células Escamosas/epidemiología , Glotis , Neoplasias Laríngeas/epidemiología , Factores de Edad , Carcinoma de Células Escamosas/secundario , Supervivencia sin Enfermedad , Finlandia/epidemiología , Humanos , Incidencia , Neoplasias Laríngeas/patología , Metástasis Linfática , Persona de Mediana Edad , Pronóstico , Análisis de Regresión , Factores de Riesgo , Factores Sexuales , Fumar/efectos adversos , Factores de TiempoRESUMEN
PURPOSE: To investigate the prognostic significance of p53 expression and proliferation markers in primary laryngeal squamous cell carcinoma. PATIENTS AND METHODS: Primary tumors for analyses were obtained from 103 patients, with complete follow-up data. All patients were treated between the years 1975 and 1990. The expression of p53 was analyzed with monoclonal D07 antibody and proliferative activity with Ki-67 (MIB-1) and PCNA (monoclonal 19A2) antibodies. Volume corrected mitotic (M/V) index and histological grade were determined in hematoxylin and cosin-stained slides. RESULTS: Sixty-eight percent of the tumors overexpressed p53. During a median follow-up of 62 months, 41 (40%) of patients relapsed. In univariate analysis site of the primary tumor, stage, p53 expression, histologic grade, and M/V index were significant predictors of disease-free survival. In multivariate analysis, only M/V index was a statistically significant predictor of disease-free survival. Overall survival was significantly better for those overexpressing p53 (10-year cumulative survival rate 68% v 44%, P = .004). In multivariate analysis, M/ V index (P = .02), p53 (P = .02), and stage (P = .007) were statistically significant predictors of overall survival. When this analysis includes stratification according to the type of treatment received, M/V index (P = .007), stage (P = .0002), and p53 (P = .006) were even more significant predictors of overall survival. No association between p53 status and proliferative activity was found. CONCLUSION: Overexpression of p53 is associated with favorable disease-free and overall survival in laryngeal squamous cell carcinoma. It may also have an independent prognostic value in laryngeal cancer. M/V index, p53 overexpression, and stage predict with significant accuracy the 10-year overall survival.
Asunto(s)
Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/patología , Regulación Neoplásica de la Expresión Génica , Neoplasias Laríngeas/química , Neoplasias Laríngeas/patología , Proteína p53 Supresora de Tumor/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , División Celular , Supervivencia sin Enfermedad , Femenino , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Pronóstico , Antígeno Nuclear de Célula en Proliferación/análisis , Modelos de Riesgos Proporcionales , Análisis de Supervivencia , Regulación hacia ArribaRESUMEN
The incidence of laryngeal cancer during the period 1962-1991 in the Tampere University Hospital area, with a population of 400000, was evaluated. There were 302 (95%) male and 16 (5%) female patients. The mean annual age-adjusted incidence rate was 4.4 per 100000 inhabitants for males and 0.2 for females. The incidence among males decreased significantly from 6.7 to 2.6 over the study period, the most prominent decline being in the age group 40-49 years. No distinct trend was detected in females. The frequency of the disease increased along with age in both sexes. One of the prominent phenomenons was a distinct increase of the glottic to supraglottic incidence ratio from 0.5:1 to 1.9:1 in males.
Asunto(s)
Neoplasias Laríngeas/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Distribución por SexoRESUMEN
In order to evaluate the etiological factors, all 318 cases of laryngeal cancer diagnosed during the period of 1962-91 in the Tampere University Hospital area with a population of 400,000 were reviewed. Among males the annual age-adjusted incidence decreased significantly from 7.1 to 2.3 per 100,000. No significant difference in the occurrence was found between urban and rural areas. In males the relative risk (RR) was significantly higher in the lower socio-economic groups. In both sexes smokers had significantly higher risk compared to non-smokers. For male smokers RR was 15.5 (95% CI 10.0-25.4) and for female smokers 12.4 (95% CI 3.9-39.5). Changes in smoking habits seem to be the most important factor contributing to the decreasing incidence of laryngeal cancer in Finland, but other factors like changes in dietary and sauna habits may also have some significance.