Carcinoma of the larynx in the elderly: Analysis of potentially significant prognostic variables

The incidence reported for carcinomas of the head and neck currently peaks between the sixth and seventh decades of life. In this retrospective study we were interested in learning whether age is a potentially significant pro gnostic factor for survival. We considered a set of variables in a series o f 134 patients, divided into two groups; between 65 and 70 years of age, an d older than 70. Stage I-II tumors were present in 44 patients, while local ly advanced lesions (stages III-IV) were present in 90. Statistical analysi s of survival was performed using the actuarial survival rates according to Kaplan-Meier; significance was evaluated using the log-rank test. Multivar iate analysis teas performed according to the Cox logistic regression model to determine the prognostic significance of any of the variables. Univaria te analysis was performed on a series of variables regarding the patient, t umor and treatment. In the younger group, age appeared to be ct favorable p rognostic factor. Tumor size had a significant effect on disease-free survi val, both globally and between the two groups (p<0.05), Lymph node status s ubstantially influenced the five-year survival rate (p=0.001). Tumor invasi on of the lymph nodes led to a difference between the two groups. Survival was lower in the younger than in the older group. There was a significant d ifference (p<0.01) in survival between patients who had undergone surgery ( 75%) and those who received radiotherapy alone (33%). Multivariate analysis of these variables showed that disease stage, and treatment of lymph nodes were both significant (p=0.0016 and p=0.0002, respectively). Survival rate s for the so-called "young elderly" (65-70 years) are generally higher than that for those aged 70 and over. Following accurate and comprehensive asse ssment by the anesthesiologist and the internist, and appropriate adjustmen t of the patient's nutritional and metabolic status, combined radical surge ry and radiotherapy can and must be performed. Minimal palliative intervent ions, in the belief that tumor growth is biologically less aggressive in th e elderly patient, should be avoided. (Aging Clin. Exp. Res. 11: 316-322, 1 999) (C)1999, Editrice Kurtis.