PROGNOSTIC FACTORS IN T3, N0-1 GLOTTIC AND TRANSGLOTTIC CARCINOMA - AMULTIFACTORIAL STUDY OF 221 CASES TREATED BY SURGERY OR RADIOTHERAPY

Objective: To evaluate prognostic factors in patients with T3,NO-1 glo ttic and transglottic carcinoma treated in a single institution. Desig n: Retrospective, nonrandomized case series. Setting: Tertiary case re ferral centers, ambulatory or hospitalized care. Patients: Two hundred twenty-one consecutive cases of stage III glottic or transglottic squ amous cell carcinoma. Tumor stage was T3,NO,MO in 167 cases and T3,N1, MO in 54 cases. Interventions: Surgery in 176 cases and radiotherapy i n 45 cases. Main Outcome Measures: Recurrences and survival (multivari ate). Results: Almost 7% of the patients who underwent surgery and 39. 6% who had radiotherapy had local recurrences. Recurrences in the neck were seen in 16.4% of the patients who underwent surgery and in 10.5% of those who had radiotherapy. Distant metastases were diagnosed only in patients who underwent surgery (4.6%). The 5-year actuarial overal l survival rates were 56.3% in the surgical group and 35.2% in the rad iotherapy group (P=.007). Age involvement of pyriform sinus, N stage, and history of tracheostomy were independent prognostic factors for ri sk of death. Conclusions: The presence of metastatic lymph nodes, age, and involvement of the pyriform sinus were the important prognostic f actors in patients who underwent surgery. A small group of patients wi th T3,NO,MO tumors could benefit from radiotherapy, with surgery reser ved for recurrence.