Tumor, Host, and Treatment Factors Define Laryngeal Cancer Outcomes

What are the prognostic factors that must be considered in decision-making for laryngeal squamous cell carcinoma (LSCC) treatment?

Bottom line: Optimal outcomes for an individual LSCC patient can be achieved when taking into account tumor, host, and treatment factors, but reliable, independent biomarkers that predict survival and treatment response still need to be established.

BACKGROUND: Current LSCC treatment results remain modest, with global five-year overall incidence rates of 154,977 male cases and 22,445 female cases in 2018. Various factors predict the outcome of malignant neoplasms of the larynx, and host, tumor, and treatment factors have an important impact on LSCC prognosis.

Study design: Literature review.

Setting: Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Mich., USA.

Synopsis: Younger age is a positive prognostic factor, and young patients develop fewer recurrences and second primary tumors. Women have a reduced risk for recurrence compared with men. Low BMI pre-treatment is significantly associated with poor overall survival, and patients with weight loss of more than 10% six months pre-surgery have a high major postoperative complication risk. Poor general condition is related to recurrence risk, and data support adverse prognostic impact with immunosuppressed patients. Increasing T class and stage is a glottic LSCC recurrence risk factor. Metastatic cancer presence or absence in cervical lymph nodes is a prognostic indicator, and distant metastases correlate with poor prognosis. Poorly differentiated cancers usually have a higher metastatic disease rate. Perineural invasion affecting the small nerve has a negative impact on patient prognosis. Many present biological parameters are of “unproven” prognostic value. However, EGFR overexpression is a poor prognostic marker, patients with negative margins by molecular analysis have significantly increased survival, and generally worse prognosis correlates with higher laryngeal cancer cell DNA content levels. The presence of a previous or synchronous cancer halves survival. An important management factor is whether the carcinoma is in situ, microinvasive, or frankly invasive.

Citation: Bradford CR, Ferlito A, Devaney KO, et al. Prognostic factors in laryngeal squamous cell carcinoma. Laryngoscope Investig Otolaryngol. 2020;1–8.