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. 2025 Jan-Dec:54:19160216251348424.
doi: 10.1177/19160216251348424. Epub 2025 Jun 18.

Outcomes Following Transoral Laser Microsurgery for T1b and T2a Glottic Squamous Cell Carcinoma With and Without Anterior Commissure Involvement: A Retrospective Chart Review

Depak Patel  1 , Victoria Taylor  1   2 , Colin MacKay  1 , Chrisje den Besten  1   3 , Matthew H Rigby  1 , Martin Corsten  1   4 , Timothy Brown  1 , Jonathan Trites  1 , S Mark Taylor  1
Affiliations

Outcomes Following Transoral Laser Microsurgery for T1b and T2a Glottic Squamous Cell Carcinoma With and Without Anterior Commissure Involvement: A Retrospective Chart Review

Depak Patel et al. J Otolaryngol Head Neck Surg. 2025 Jan-Dec.

Abstract

ImportanceThere is a limited understanding of anterior commissure (AC) involvement in glottic squamous cell carcinoma (SCC), particularly when comparing T1b, T2a with AC involvement (T2AC), and T2a without AC involvement (T2noAC).ObjectiveThe aim of this study was to compare oncological and functional outcomes in T1b, T2AC, and T2noAC glottic SCC following transoral laser microsurgery (TLM).DesignRetrospective chart review.SettingThe Queen Elizabeth II Health Science Centre (Halifax, Nova Scotia) from January 1, 2002, to December 31, 2022.Intervention and ExposuresA retrospective chart review was completed using prospectively-collected data for patients treated with TLM for T1b and T2a glottic SCC. Exclusion criteria included previous treatment for a laryngeal cancer and T2b glottic SCC.Main Outcome MeasuresOncological outcomes were assessed using margin status, local control (LC), disease-specific survival (DSS), overall survival (OS), and laryngeal preservation (LP). Functional outcomes were measured using the abbreviated Voice Handicap Index-10 (VHI-10).ResultsIn total, 117 patients were included (T1b = 46, T2AC = 53, T2noAC = 18). Positive margins were higher in the T2AC group (15.1%) than in T1b (4.3%) and T2noAC (5.6%; P = .208). At 5 years, there were no significant differences in LC (T1b = 80.8%, T2AC = 70.3%, T2noAC = 76.2%; P = .26), DSS (T1b = 100%, T2AC = 90.2%, T2noAC = 93.8%; P = .45), OS (T1b = 88.3%, T2AC = 76.1%, T2noAC = 93.8%; P = .69), or LP (T1b = 94.3%, T2AC = 92.1%, T2noAC = 94.4%; P = .74). Significant improvements in VHI-10 scores from the pre- to postoperative period were only noted in the T1b cohort, at the 6 months (P = .017) and the 12 months (P = .00143).ConclusionsNo significant differences in both oncological and functional outcomes were noted between T1b, T2AC, and T2noAC glottic SCCs. Further stratifying based on the degree and pattern of AC involvement with larger sample sizes may provide important prognostic factors.RelevanceThis study highlights that T2 glottic SCCs with normal vocal fold mobility are a heterogenous group, and it may be beneficial to further stratify these cancers according to AC involvement, particularly when considering TLM.

Keywords: glottic cancer; laryngeal cancer; transoral laser microsurgery.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Local control rates of T1b (red), T2AC (blue), and T2noAC (green) over 5 year period.
Figure 2.
Figure 2.
Kaplan-Meier curve representing disease-specific survival of T1b (red), T2AC (blue), and T2noAC (green).
Figure 3.
Figure 3.
Kaplan-Meier curve representing overall survival of T1b (red), T2AC (blue), and T2noAC (green).
Figure 4.
Figure 4.
VHI-10 raw scores pre-operatively and post-operatively at 3, 6, and 12 months. VHI-10, Voice Handicap Index-10. **P < .01. ****P < .0001.
Figure 5.
Figure 5.
VHI-10 raw scores pre-operatively and post-operatively at 3, 6, and 12 months stratified by anterior commissure involvement for T1b (red), T2AC (blue), and T2noAC (green). VHI-10, Voice Handicap Index-10. *P < .05. **P < .01.
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