Refining prognostic subcategories in intermediate-advanced glottic cancer: A multicentric study on 637 patients treated by transoral laser microsurgery
- Filippo Marchi 1, Francesca Del Bon 2, Francesco Chu 3, Claudio Sampieri 4, Elisa Bellini 1, Davide Lancini 2, Stefano Zorzi 3, Laura Ruiz-Sevilla 5, Marta De Vecchi 1, Aurora Pinacoli 6, Giacomo Pietrobon 3, Rosa-Delia Ramirez 7, Pietro Benzi 1, Jacopo Di Domenico 6, Francesc Xavier Avilés-Jurado 8, Marta Filauro 9, Gabriele Zigliani 2, Francesco Mora 1, Alessandra Sordi 6, Claudia Montenegro 6, Isabel Vilaseca 8, Cesare Piazza 6, Mohssen Ansarin 3, Giorgio Peretti 1
- 1Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Science (DISC), University of Genoa, School of Medicine, Genoa, Italy.
- 2Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy.
- 3Department of Otorhinolaryngology - Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
- 4Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain; Head and Neck Cancer Unit, Hospital Clinic, Barcelona, Spain; Department of Experimental Medicine (DIMES), University of Genoa, School of Medicine, Genoa, Italy.
- 5Department of Otorhinolaryngology, Hospital Universitari Joan XXIII, Tarragona, Spain.
- 6Unit of Otorhinolaryngology - Head and Neck Surgery, ASST Spedali Civili of Brescia, Brescia, Italy; Department of Surgical and Medical Specialties, Radiologic Sciences, and Public Health (DSMC), University of Brescia, School of Medicine, Brescia, Italy.
- 7Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain; Head and Neck Cancer Unit, Hospital Clinic, Barcelona, Spain; Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, University of Barcelona, Barcelona, Spain.
- 8Department of Otorhinolaryngology, Hospital Clinic, Barcelona, Spain; Head and Neck Cancer Unit, Hospital Clinic, Barcelona, Spain; Department of Surgery and Medical-Surgical Specialties, Faculty of Medicine, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Head and Neck Clinic, Agencia de Gestio d'Ajuts Universitaris i de Recerca, Barcelona, Spain.
- 9Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- 0Unit of Otorhinolaryngology - Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Science (DISC), University of Genoa, School of Medicine, Genoa, Italy.
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View abstract on PubMed
Summary
This summary is machine-generated.Transoral laser microsurgery (TOLMS) offers good outcomes for intermediate-advanced glottic squamous cell carcinoma (SCC). Posterior paraglottic space involvement is a key risk factor for recurrence and laryngectomy.
Area Of Science
- Otolaryngology
- Head and Neck Surgery
- Oncology
Background
- The TNM staging system has limitations in describing glottic squamous cell carcinoma (SCC) extension and subsite involvement, particularly after transoral laser microsurgery (TOLMS).
- Accurate staging is crucial for predicting outcomes in glottic SCC treated with TOLMS.
Purpose Of The Study
- To evaluate oncologic outcomes after TOLMS for intermediate-advanced glottic SCC.
- To stratify patients based on anatomical tumor extension using refined prognostic subcategories.
- To identify specific subsite involvement predicting poorer outcomes.
Main Methods
- Retrospective analysis of 637 previously untreated patients with pT2-T3 glottic SCC treated with TOLMS across four European centers.
- Stratification into five subcategories (III, IV, Va, Vb, VI) based on three-dimensional local tumor extension.
- Evaluation of 5-year disease-specific survival, local control, and laryngeal preservation rates.
Main Results
- The overall 5-year disease-specific survival was 91%, local control 81%, and laryngeal preservation 87%.
- Subcategories Va (anterior paraglottic space involvement) and Vb (posterior paraglottic space involvement) showed significantly poorer outcomes.
- Posterior paraglottic space involvement (Vb) was associated with the highest risk of local recurrence and laryngectomy (HR: 3.70).
Conclusions
- TOLMS is a viable treatment for T2-T3 glottic SCC, achieving high laryngeal preservation and oncologic outcomes in selected patients.
- Stratification by tumor subsite involvement offers critical prognostic information.
- Posterior paraglottic space invasion is a significant risk factor for adverse outcomes.
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