Stomal recurrence in patients with T1 glottic cancer after salvage laryngectomy for radiotherapy failures - Role of p53 overexpression and subglotticextension

The role of p53 overexpression in the development of stomal recurrence was studied in patients with T1 glottic cancer who had undergone salvage laryng ectomy after primary radiotherapy failure (first recurrence). The role of s ubglottic extension of the recurrent tumor in the development of stomal rec urrence was also studied. One hundred fourteen patients with T1 squamous ce ll carcinoma of the glottic larynx were irradiated with curative intent. A local recurrence (first recurrence) developed in 23 patients (20%), and sal vage laryngectomy was performed for 20 of these patients. No postlaryngecto my radiation therapy was included in the treatment of recurrences. Several risk factors thought to be significant in the development of stomal recurre nce were analyzed in these 20 patients. Prognostic factors analyzed include : p53 overexpression in the preradiation biopsy specimen, subglottic extens ion of the first recurrence, thyroid cartilage and lymph node involvement a t the time of first recurrence, emergency tracheostomy performed before sal vage laryngectomy, and the laryngectomy procedure performed for first recur rence.. Presence of p53 protein in the preradiation biopsy specimen of lary ngeal cancer did not show any adverse effect on the development of stomal r ecurrence. Stomal recurrence developed in 27% of patients with positive bio psies and in 20% of patients with negative biopsies (p = 1.00). Subglottic extension of the first recurrence was associated with an increased incidenc e of stomal recurrence. Rates of stomal recurrence were 6% in patients with out subglottic extension and 100% in patients with subglottic extension (p = 0.001). All other risk factors studied showed no effect on stomal recurre nce. In this study p53 overexpression showed no effect on the development o f stomal recurrence after salvage laryngectomy in patients with T1 glottic cancer. Conversely, subglottic extension of the recurrence was found to be strongly associated with stomal recurrence. Ail other factors analyzed show ed no effect on stomal recurrence.