Oncologic Outcomes After Salvage Laryngectomy for Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter R
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ORIGINAL ARTICLE – HEAD AND NECK ONCOLOGY
Oncologic Outcomes After Salvage Laryngectomy for Squamous Cell Carcinoma of the Larynx and Hypopharynx: A Multicenter Retrospective Cohort Study Jeroen Meulemans, MD1,2, Jens Debacker, MD3, Hannelore Demarsin, MD1, Christophe Vanclooster, MD4, Peter Neyt, MD4, Tillo Mennes, MD1,5, Tom Vauterin, MD5, Wouter Huvenne, MD, PhD3,6, Annouschka Laenen, MSc7, Pierre Delaere, MD, PhD1, and Vincent Vander Poorten, MD, PhD, MSc1,2 1
Otorhinolaryngology-Head and Neck Surgery, University Hospital Leuven, Louvain, Belgium; 2Department of Oncology, Section Head and Neck Oncology, KU Leuven, Louvain, Belgium; 3Department of Head and Skin, Ghent University, Ghent, Belgium; 4Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Lucas, Ghent, Belgium; 5 Otorhinolaryngology-Head and Neck Surgery, AZ Sint-Jan, Brugge, Belgium; 6Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium; 7Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Louvain, Belgium
ABSTRACT Objective. We aimed to analyze oncologic outcomes and identify patterns of failure and negative prognostic factors in patients who underwent salvage total laryngectomy (STL) for residual, recurrent, and second primary squamous cell carcinoma (SCC) of the larynx and hypopharynx. Methods. This was a retrospective cohort study of patients who underwent STL in four major Belgian reference hospitals between 2002 and 2018 for residual/recurrent/second primary SCC in the larynx or hypopharynx after initial (chemo)radiation. Prognostic factors for oncologic outcomes were identified using univariable and multivariable analysis. Results. A total of 405 patients were included in the final analysis. Five-year overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), and locoregional relapse-free survival (LRFS) estimates were 47.7% (95% confidence interval [CI] 42.0–53.2%), 68.7% (95% CI 63.7–73.7%), 42.1% (95% CI 36.7–47.4%), and 44.3%
(95% CI 38.8–49.7%), respectively. In a multivariable model, increasing clinical tumor stage of the residual/recurrent/second primary tumor, increasing number of metastatic cervical lymph nodes retrieved during neck dissection, hypopharyngeal and supraglottic tumor location, positive section margin status and perineural invasion were independent negative prognostic variables for OS, DSS, DFS, and LRFS. The type of second tumor was identified as an additional independent prognosticator for DSS, with local recurrences and second primary tumors having a better prognosis than residual tumor. Conclusions and Relevance. Favorable oncologic outcomes are reported after STL. Increasing clinical tumor stage, increasing number of metastatic cervical lymph nodes, hypopharyngeal and supraglottic tumor location, positive section margins, and perineural invasion are identified as independent negative prognosticators for all oncologic outcome measures. Keywords Hypopharynx Larynx Oncologic outcomes Salvage surgery Squamous cell carcinoma Total laryngectomy
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