Prognosis in laryngeal carcinoma: tumour factors

A personal series of 765 previously untreated patients with laryngeal carcinoma seen between 1962 and 1988 was analysed for the importance of prognostic factors. There were numerous significant correlations between tumour prognostic factors, particularly with neck node status. Palpable cervical nodes increased in frequency with increasing T status, and palpable lymph nodes were commoner in less well differentiated tumours, and in supra and sub-glottic tumours. These correlations were very highly significant. Increasing T stage was associated with increasing N stage. T stage was also associated with site, glottic tumours being far more likely to be T1 than supra or sub-glottic tumours. T stage was not related to histological grade. Histological grade correlated with site, glottic tumours being well differentiated much more often. When survival was analysed by univariate methods there were highly significant differences with increasing T stage and N stage, between the various histological grades and the various sites. However, when survival was analysed by multifactorial methods taking interactions into account, only N status was a significant prognostic factor. When patients with palpable nodes submitted to surgery were analysed, it transpired that clinical staging and node level were relatively unimportant compared with pathological findings: both the number of nodes invaded and the presence of tumour outside lymph nodes (extracapsular rupture) were highly significant.