Tumor volume as a prognostic factor of locally advanced laryngeal cancer
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HEAD AND NECK
Tumor volume as a prognostic factor of locally advanced laryngeal cancer Natália Martins Magacho de Andrade1 · Rogério Aparecido Dedivitis1 · Daniel Marin Ramos2 · Leandro Luongo Matos1,2 · Marcio Ricardo Taveira Garcia3 · Gustavo Gonçalves Conti3 · Luiz Paulo Kowalski4 Received: 17 April 2020 / Accepted: 12 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The TNM tumor staging system is the most widely used for laryngeal cancer. However, in the same T stage, lesions with different primary tumor volumes (TV) can be found, impacting treatment outcomes. Methods 145 patients with T3 and T4a laryngeal cancer, according to Union for International Cancer Control, who underwent surgical treatment from 2008 to 2017, were analyzed. TV measurements were collected and compared to different outcomes. Results The mean TV was 23.0 ± 16.4 cm3. A cutoff point for TV of 14.2 cm3 was established. Cumulative sample 5-year overall survival (OS) was 62.1%, while 5-years disease-free survival (DFS) was 65.5%. In univariate analysis, TV ≥ 14.2 cm3 was associated with a higher risk of distant metastases (p = 0.045), and worse rates of OS (p = 0.009) and DFS (p = 0.035). In multivariate analysis, TV was not an independent risk factor of worse DFS (p = 0.569) or OS (p = 0.094). Conclusion Primary lesion TV showed significant association, in univariate analysis, with worse rates of recurrence and survival in advanced laryngeal cancer undergoing surgical treatment and can be a promising prognostic for these patients. Keywords Laryngeal neoplasms · Imaging · Three-dimensional · Neoplasm staging · Prognosis · Survival
Introduction Laryngeal cancer (LC) accounts for 0.7% of all malignant diseases affecting North American individuals. The National Cancer Institute estimates 12,410 new cases in the year 2019 for the United States, with an overall 5-year survival rate of 60.3% [1]. The TNM system for tumor staging is the most widely used in head and neck neoplasms. It can predict survival rates after treatment [2], and the standardization of data * Natália Martins Magacho de Andrade [email protected] 1
Department of Head and Neck Surgery, Instituto Central, University of Sao Paulo Medical School, 8° andar. Cerqueira César, São Paulo 05403‑000, Brazil
2
Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
3
Department of Radiology, Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
4
Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
allows comparative studies with other institutions [3]. However, at the same T stage (primary tumor), a variety of lesions with different tumor volumes may be found, impacting directly on local disease control after the treatment of choice [4]. A typical example is superficial neoplasm, which often receives the same T classification as more infiltrative tumors. The same occurs with the N stage, which includes lymph node metastases with different extension
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