Predictors of local recurrence of glottic cancer in patients after transoral laser microsurgery

Abstract

Background: Transoral laser microsurgery (TLM) is used to treat early and select cases of moderately advanced glottic cancer, with results equivalent to those of conventional conservative surgery and radiotherapy (RT). As surgeons and researchers become more experienced and familiar with TLM, they can focus on mechanisms to earlier detect local recurrence, to more effectively preserve laryngeal function. This study analyzed the predictors of local recurrence in glottic cancer patients who underwent TLM.

Methods: Our study focused on 93 consecutive patients with glottic cancer who received TLM between 2003 and 2009, and were analyzed retrospectively. All of these patients were treated by the same surgeon. The local control and survival rate were calculated with Kaplan-Meier method and compared using the log-rank test. Additionally, the Cox proportional hazard model was used for multivariate analysis.

Results: The 5-year local control, overall survival, and disease-specific survival rates were 87%, 95%, and 96%, respectively. The final laryngeal preservation rate was 98%. Independent predictors of local recurrence were arytenoid cartilage invasion (hazard ratio [HR], 6.5; 95% confidence interval [CI], 2.1-26.6), difficult laryngeal exposure (HR, 4.6; 95% CI, 1.5-17.3), previous microlaryngoscopic surgery (HR 3.1; 95% CI, 1.3-10.5), positive surgical margin (HR, 2.7; 95% CI, 1.1-9.7), and endophytic tumors (HR, 2.6; 95% CI, 1.1-7.6).

Conclusion: TLM is a reliable modality to treat early and select cases of moderately advanced glottic cancer with good final laryngeal preservation rate. Our study found that independent factors of local recurrence included arytenoid cartilage invasion, difficult laryngeal exposure, previous microlaryngoscopic surgery, positive surgical margin and endophytic tumors. These findings may help to follow-up glottic cancer patients after TLM.

Keywords: Carbon dioxide laser; Glottis; Local recurrence; Squamous cell carcinoma.