[Clinical analysis of 57 patients with poorly differentiated carcinomas of the supraglottic larynx].

OBJECTIVE

To investigate the clinical characteristics, treatment and prognosis for poorly differentiated supraglottic carcinomas.

METHODS

A retrospective study was conducted in 57 cases of poorly differentiated supraglottic carcinomas treated in our hospital from 1980 to 1998. The distribution of the patients according to UICC in 1997 was as follows: stage I 4, stage II 15, stage III 18, stage IV 30. Of the 57 patients, 25 were treated with surgery alone, 9 with irradiation alone, 14 with surgery following preoperative radiation, 7 with postoperative radiation following surgery and 2 with surgery following preoperative chemotherapy. Total laryngectomy was performed on 23 patients and partial laryngectomy on 25 patients. The concurrent neck dissections were undergone for 31 cases (17 unilateral side, 14 bilateral side) and the upper neck dissections for 12 cases.

RESULTS

The overall 5-year survival rate, accumulated cervical metastasis rate, metastasis rate of bilateral side of neck, distant metastasis rate, cervical recurrent rate and locally recurrent rate were 47.4% (27/57), 63.2% (36/57), 24.6% (14/57), 21.1% (12/57), 28.1% (16/57) and 10.5% (6/57), respectively. In addition, the local recurrent rate for partial laryngectomy was 12% (3/25). 5-year survival rate for each TNM staging decreases gradually. The difference in 5-year survival rate between T1 + T2 and T3 + T4 and the difference between N0 + N1 and N2 + N3 were statistically significant (chi2 = 4.942, P = 0.026; chi2 = 4.306, P = 0.038). No evidence in our analysis was found about the difference in 5-year survival rate between surgery alone and surgery combined with radiotherapy. The effect of surgery combined with radiotherapy on patients at N2 and N3 was relatively superior to that of surgery alone.

CONCLUSIONS

Poorly differentiated carcinomas of the supraglottic larynx had characteristics of the advanced stage in terms of earlier lymph node metastasis and a relatively high rate of cervical and distant metastasis. Surgery was still the primary treatment for this disease and it was feasible to perform partial laryngectomy on certain patients. For patients with T3 who need partial laryngectomy and patients with advanced N stage, the combination of surgery with radiotherapy was supposed to be a priority.