[Clinical classification of laryngeal carcinoma. Critique of existing classifications and proposal of a new working classification].

Clinical classification of cancer of the larynx is an intriguing problem that has not been yet solved by the several proposals followed on during thirty years. The main disagreement deals with their aims that have become strictly prognostic, with no egard for therapeutic indications in individual cases. Apart from this aspect, the prognostic factors taken into account even by the last drawing (TNM UICC 1987) seem too rough to allow a correct statistical comparison among the different therapeutic modalities that can be applied to each clinical situation. This lack becomes exceedingly relevant when controlled therapeutic trials are to be planned, comparing radiotherapy with the various types of surgical procedure. A careful critical review of the successive clinical classifications (UICC, AJC) is made and a new descriptive working classification (CLM) is proposed. It aims first of all at a more rational organization of the main prognostic factors to be considered for all locations and stages, with no radical distortion of the last TNM UICC staging system, some details excepted. Afterwards each stage is subdivided into substages according to the presence or absence of those prognostic factors of known influence on applicability and outcome of all various therapeutic modalities, with particular emphasis to some pending problems. CLM classification makes it possible to set up homogeneous groups of cases on which every type of prospective or retrospective comparison of different treatments can be made. Advantages of the CLM working classification are: no need for further modification; possibility of giving information, after appropriate check, about therapeutic indications; possibility of moving quickly and simply subcategories of cases with similar prognosis from CLM to TNM.