Tumour-host relationship and its implications in the treatment and long-term prognosis of laryngeal cancer. Critical observations on the TNM system of tumour classification.

The choice of surgical and/or X-ray treatment of a laryngeal cancer is usually established by taking into consideration the site of the tumor and its extension. The histologic type is considered only when this is easily identifiable, whereas the histologic grade of cellular differentiation and the tumour-host relationship are always erroneously disregarded. These latter factors are of a basic importance in establishing a "tailor-made" therapeutic programme for each patient and the long-term prognosis. The above factors have led to a new critical approach to laryngeal cancer and have also made it possible to obtain some practical results: 1 degrees the correct definition of the verrucous squamous cell carcinoma of the larynx, which is the result of the highest local defensive reaction to tumour growth (mediated by thymus-dependent lymphocytes); 2 degrees a criticism of the present trend to perform a more conservative surgery decided only opon the basis of the site and extension of the neoplasm; conservation surgery must be adopted for patients with an intense cellular immune response around the tumour and with a moderate histologic grade of malignancy; 3 degrees a criticism of the present criteria in establishing the long-term survival, which do not include the early immune response; 4 degrees the necessity of a systematic histologic study of the surgical specimen so as to evaluate the intensity of the immune reaction both around the tumour and in regional lymph nodes. In the light of these new data, the TNM system of tumour classification is now outdated, as witnessed by the constant efforts to adapt it to the unpredictable behaviour of malignant disease.