Locatello Luca Giovanni, Pietragalla Michele, Taverna Cecilia, Bonasera Luigi, Massi Daniela, Mannelli Giuditta
1 Division of Otorhinolaryngology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
2 Division of Radiology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
Ann Otol Rhinol Laryngol. 2019 Jan;128(1):36-43. doi: 10.1177/0003489418806915. Epub 2018 Oct 26.
: Laryngeal squamous cell carcinoma (LSCC) can involve different anatomic subunits with peculiar surgical and prognostic implications. Despite conflicting outcomes for the same stage of disease, the current staging system considers different lesions in a single cluster. The aim of this study was to critically discuss clinical and pathologic staging of primary and recurrent advanced LSCC in order to define current staging pitfalls that impede a precise and tailored treatment strategy.
: Thirty patients who underwent total laryngectomy in the past 3 years for primary and recurrent advanced squamous cell LSCC were analyzed, comparing endoscopic, imaging, and pathologic findings. Involvement of the different laryngeal subunits, vocal-fold motility, and spreading pattern of the tumor were blindly analyzed. The diagnostic accuracy and differences between clinicoradiologic and pathologic findings were studied with standard statistical analysis.
: Discordant staging was performed in 10% of patients, and thyroid and arytenoid cartilage were the major diagnostic pitfalls. Microscopic arytenoid involvement was significantly more present in case of vocal-fold fixation ( P = .028). Upstaging was influenced by paraglottic and pre-epiglottic space cancer involvement, posterior commissure, subglottic region, arytenoid cartilage, and penetration of thyroid cartilage; on the contrary, involvement of the inner cortex or extralaryngeal spread tended to be down-staged. Radiation-failed tumors less frequently involved the posterior third of the paraglottic space ( P = .022) and showed a significantly worse pattern of invasion ( P < .001).
: Even with the most recent technologies, 1 in 10 patients with advanced LSCC in this case series was differently staged on clinical examination, with cartilage involvement representing the main diagnostic pitfall.
喉鳞状细胞癌（LSCC）可累及不同的解剖亚单位，具有独特的手术及预后意义。尽管相同疾病分期的结果存在矛盾，但当前的分期系统将不同病变归为单一类别。本研究旨在批判性地讨论原发性和复发性晚期LSCC的临床及病理分期，以明确阻碍精确且个性化治疗策略的当前分期缺陷。
分析过去3年因原发性和复发性晚期鳞状细胞LSCC接受全喉切除术的30例患者，比较内镜、影像学及病理检查结果。对不同喉亚单位的受累情况、声带活动度及肿瘤扩散模式进行盲法分析。采用标准统计分析研究临床放射学与病理检查结果之间的诊断准确性及差异。
10%的患者分期不一致，甲状腺和杓状软骨是主要的诊断陷阱。声带固定时，显微镜下杓状软骨受累更为显著（P = .028）。分期上调受声门旁间隙和会厌前间隙癌累及、后联合、声门下区、杓状软骨及甲状腺软骨穿透影响；相反，内皮质受累或喉外扩散往往导致分期下调。放疗失败的肿瘤较少累及声门旁间隙后三分之一（P = .022），且侵袭模式明显更差（P < .001）。
即使采用最新技术，本病例系列中10%的晚期LSCC患者在临床检查时分期不同，软骨受累是主要的诊断陷阱。
