[An attempt to evaluate prognosis in cases of metastasis from laryngeal and hypopharyngeal carcinoma to cervical lymph nodes].
The objective of the paper was the retrospective evaluation of oncological results after dissection radical (RND), modified (MND) and selective (SND) on cervical lymph nodes in laryngeal and hypopharyngeal carcinoma. On the basis of obtained study results, an answer was sought whether and what prognostic factors in metastases to the regional cervical lymph nodes should influence the choice of therapeutic method, and the survival. The study material comprised 986 patients treated during the period 1970-1991 in the Department of Otolaryngology-PAM in Szczecin due to laryngeal and hypopharyngeal carcinoma. In this group, apart from treating the primary changes, the cervical lymph nodes were operated on (Neck Dissection-ND). Data concerning the patients were obtained from: a/ case histories, b/ follow-up, c/ correspondence, d/ USC data. Clinical status of cervical lymph nodes, their histopathological state were assessed postoperatively. The patients' survival period after the treatment of carcinoma was estimated too. The occurrence of neoplastic disease recurrence in cervical lymph nodes was also taken into consideration. All data were collected in Personal Computer memory IBC (PC 386). In processing the data use was made of calculating and data base program Medikus. A linear regression model was elaborated for investigating the degree to which certain factors influence the appearance of nodal recurrence. Hierarchy was established for the factors whose influence on the occurrence of recurrence was the strongest. It becomes apparent from the accomplished studies that metastases to the regional cervical lymph nodes occurred most frequently in hypopharyngeal cancers (81.6%). The clinical assessment is burdened with an error claiming 31% of discrepancy as compared to results of histopathological examination (Tab. 3). Occult metastases were recorded in hypopharyngeal carcinoma about 20%, and in glottic one about 13%. It was revealed that the presence of metastases in lymph nodes, an increase affecting the stage of pT and pN reduced the chances of survival in a significant manner (Tab. 7 and 8). The greatest influence on the appearance of nodal recurrence was exerted by the following factors: number of metastatic nodes, size of nodes, component N, mode of treatment. It has been disclosed that the risk of nodal recurrence increases sixfold with the rise of factor N, twofold with the rise of the number of metastatic nodes, and 1,6 fold when the size of nodes increases by 1 cm. No differences were observed in the percentages of survivals following the operative treatment RND and MND, with the stage being N1-2 (Fig. 1). Radiotherapy applied after MND and RND failed to exert any meaningful positive influence on the overall percentage of survivals (Tab. 4). As compared with therapeutic dissection, better oncological results, scored after prophylactic removal of cervical lymphatic system, provide the basis for elective performance of prophylactic procedures in hypopharyngeal and laryngeal carcinomata.
Sieczka
J P
JP
Kliniki Otolaryngologii Pomorskiej Akademii Medycznej w Szczecinie.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate