Classification of laryngeal diseases including laryngeal cancer, benign mucosal disease, and vocal cord paralysis by artificial intelligence using voice analysis.

Voice change is often the first sign of laryngeal cancer, leading to diagnosis through hospital laryngoscopy. Screening for laryngeal cancer solely based on voice could enhance early detection. However, identifying voice indicators specific to laryngeal cancer is challenging, especially when differentiating it from other laryngeal ailments. This study presents an artificial intelligence model designed to distinguish between healthy voices, laryngeal cancer voices, and those of the other laryngeal conditions. We gathered voice samples of individuals with laryngeal cancer, vocal cord paralysis, benign mucosal diseases, and healthy participants. Comprehensive testing was conducted to determine the best mel-frequency cepstral coefficient conversion and machine learning techniques, with results analyzed in-depth. In our tests, laryngeal diseases distinguishing from healthy voices achieved an accuracy of 0.85-0.97. However, when multiclass classification, accuracy ranged from 0.75 to 0.83. These findings highlight the challenges of artificial intelligence-driven voice-based diagnosis due to overlaps with benign conditions but also underscore its potential.

Non-Surgical Treatment Prognosis For Laryngeal Cancer Based On American Joint Committee On Cancer Staging And T And N Integer Score.

Background: The American Joint Committee on Cancer (AJCC) system is the most acceptable staging method. In this study, an attempt has been made to evaluate the survival rate of laryngeal cancer based on the AJCC and T and N integer scores (TANIS). Methods: In this prospective cohort study, from March 2004 to March 2021, laryngeal cancer patients who were considered for non-surgical treatment were included. Radiation alone was considered for T1-T2 lesions without nodal involvement. Sequential or concomitant chemoradiation (based on physician choice) was considered for locoregionally advanced patients (T3/T4 or node positive). The 2-year, 5-year and 10-year overall survival (OS) and progression-free survival (PFS) rates were estimated using Kaplan-Meier method. Cox -Regression method was used for covariates analysis. Results: The 2-year, 5-year and 10-year overall survival (OS) rates in all patients were estimated to be 82%, 70% and 41%, respectively. The 2-year, 5-year and 10-year progression-free survival (PFS) rates in all patients were estimated to be 78%, 59% and 41%, respectively. The 5-year OS rates for stages I, II, III, IVa, and IVb were 83, 84, 51, 12, and 19 percent, respectively. The 5-year OS rates for TANIS 1, 2, and 3 were 85, 62 and 53 percent, respectively. Based on multivariate analysis, the group stage (p=0.001), TANIS group (p=0.003) and tumour subsite. (p=0.006) were independently effective in survival rates. Conclusion: TANIS-3 can simply predict the prognosis of non-surgically treated laryngeal cancers. The separation of different prognostic groups by TANIS is better than the AJCC system. More extensive studies are necessary to confirm this.

Changing Trend in the Etiological Spectrum of Hoarseness of Voice in Rural India: A Prospective Hospital-Based Study.

Hoarseness of voice is one of the common symptoms with which patient presents to an otorhinolaryngologist. Hoarseness is a symptom of diverse etiology. The aim of the study was to study the problem of hoarseness relating to its incidence and to identify the common etiologies and predisposing factors leading to hoarseness of voice. This study comprises of 70 cases of hoarseness presenting to Department of Otorhinolaryngology, VIMS, Ballari, Karnataka from October 2015 to March 2017. After taking a thorough history, a complete otolaryngological examination was carried out and supported by relevant investigations, diagnosis was reached. The incidence of hoarseness of voice was noted to be 0.21% in our study. The majority of patients were in 31-40 years and 51-60 years of age group, and male to female ratio was 3.7:1, farmers constituted single largest group (34.3%), and most of the patients were from the rural area (82.9%). Smoking was the commonest habit (54.29%) predisposing to hoarseness of voice. Maximum patients presented with hoarseness of duration of 1-3 months. Laryngeal malignancy was the commonest aetiology noted in our study (38.6%). A complaint of hoarseness may represent a serious disease and, therefore, should not be ignored, especially if present for more than 2 weeks. It needs a complete evaluation to rule out malignancy as a cause.

Awake videolaryngoscopic orotracheal intubation in patients with laryngeal tumour using the C-MAC D-Blade.

Background and Aims: This study assessed the applicability of C-MAC videolaryngoscope (VL) D-blade for awake intubation in patients with laryngeal tumour. The primary study objective was to determine the rate of successful intubation in the first attempt. The other parameters recorded were number of attempts required for intubation, duration of different stages of intubation, haemodynamics, ease of intubation and patient comfort on visual analogue scale (VAS) postoperatively. Methods: Thirty patients were studied. Patients were sedated with dexmedetomidine and fentanyl as a slow bolus (over 20 min) and Ramsay sedation score was assessed. Topicalisation of the oropharynx, tonsillar pillars and base of the tongue was done with lignocaine 10% spray. Four ml of 4% lignocaine using MADgic atomiser was used for anaesthetising the glottis and the tracheal lumen. Results: Successful intubation was achieved in 86.6% patients in first attempt and 13.3% in two attempts. Total time for all intubations was less than 30 seconds. Fremantle score was F-1-C-MAC D-blade (easy intubation with full view) in 60% patients, while 23.3% had F-2-C-MAC D-blade (full view and either required more than one attempt or a modified technique), 13.3% had P-1-C-MAC D-blade (partial view with easy intubation) and 3.3% had P-2-C-MAC D-blade (partial view and required more than one attempt or a modified technique). The VAS score for anaesthesiologist's ease and for patient's experience was 85.83 ± 7.20 and 86.66 ± 14.46, respectively. Conclusion: C-MAC VL D-blade-assisted awake intubation is an effective and safe method to manage the airway of patients with laryngeal tumour once adequate topicalisation is ensured before the procedure.

Laryngeal Metastatic Lesions: A Literature Review.

BACKGROUND: Cancer ravages all aspects of a patient's life. In recent decades, there has been a substantial paradigm shift in the treatment of cancer with an emphasis on quality of life and patient comfort. Patients are treated holistically, a complex task given how multifaceted cancers are. Voice, a subtle indicator of patients' well-being is affected commonly by malignancies. One of the various ways by which voice is disturbed by non-laryngeal cancers is through metastasis to the larynx and adjacent areas. Metastasis to the larynx is rare but well-documented. If not diagnosed in a timely fashion, it can have devastating consequences on patients from life-threatening airway obstruction to progressive dysphonia that erodes their quality of life. Metastatic lesions of the larynx usually appear submucosal with intact overlying mucosa and are located most commonly in the supraglottis. Deep biopsies usually are needed for diagnosis, and management may entail endoscopic resection or other treatments. OBJECTIVES: This paper reviews the literature to identify typical features of laryngeal metastatic lesions of the ten cancers that are among the most common worldwide, ie, skin, renal, breast, colorectal, lung, prostate, thyroid and liver. By summarizing their most prevalent locations in the larynx, type and appearance, the authors hope to aid physicians in their diagnostic process, particularly in cases in which laryngeal involvement is the first presenting sign of a malignancy.

Granular cell tumor of the vocal cord: Case Report and Literature Review.

INTRODUCTION AND IMPORTANCE: Granular cell tumors (GCT) are rare neoplasms. The most common places are the head and neck. The larynx accounts for 3-10% of cases. PRESENTATION OF CASE: We present the case of a man who consulted our Department of Otorhinolaryngology due to long-term progressive dysphonia without dyspnea or dysphagia. Fibrolaryngoscopy revealed a tumor that affected the left vocal cord. The tumor was surgically resected. The histopathological report revealed a laryngeal GCT. Fourteen months after surgery, the patient had no recurrence. CLINICAL DISCUSSION: Patients with GCT of the larynx typically have persistent hoarseness, stridor, dysphagia and otalgia, but can also be asymptomatic. A definitive diagnosis is provided by histopathology with immunohistochemistry, and the treatment of choice is surgical resection. Unlike the literature, our report concerns a young man. CONCLUSION: Granular cell tumor is a rare tumor of the larynx and should be considered a differential diagnosis in all adult men with long-standing dysphonia.

Anesthetic Management of a Patient With Common Carotid Artery Stenosis Undergoing Laryngeal Carcinoma Surgery: A Case Report.

Laryngectomy is a common surgery for an oncosurgeon, but underlying carotid compromise is a serious concern for anesthesiologists, making this routine procedure a high-risk one. The utmost vigilance of the anesthesiologist is demanded by the surgery to prevent morbidities such as hemiplegia, hemiparesis, or speech abnormalities that may occur due to perfusion insufficiency secondary to the mechanical blockage of the carotid arteries. Hence, an undiagnosed case of carotid artery block may result in disastrous consequences for the patient, surgeon, and anesthesiologist. Hence, it is imperative to perform all the pre-operative investigations with due diligence. We present the case of a 74-year-old male who was admitted to our set-up for laryngeal carcinoma surgery. The patient had received chemoradiotherapy (CRT) six months earlier. He complained of hoarseness in his voice and a painless neck mass. He was a known case of hypertension for 14 years, controlled by oral medication, and had a history of stroke five years ago, when he was also diagnosed with a completely blocked right common carotid artery (CCA) and a partially blocked left common carotid artery.

Transoral robotic resection of unusual spindle cell/pleomorphic lipoma of the larynx.

Spindle cell/pleomorphic lipoma (SC/PL) is a subcutaneous mass usually localised on nape, shoulder or upper back. It is a benign lipogenic tumour composed of primitive CD34-positive spindle cells, floret-like multinucleated giant cells and mature adipocytes. Complete surgical excision is the optimal treatment. This unusual tumour in the larynx has only been reported in the medical literature once and was treated surgically by open approach. Actually, transoral robotic surgery (TORS) is most suitable because provides tridimensional magnified view plus a greater mobility with instruments, allowing complete and safe removal of the supraglottic mass, allowing rapid healing and recovery. We present the first case of a SC/PL of larynx managed with TORS. Four hours after surgery, the patient was able to take a soft diet and was discharged 2 h later. The follow-up showed an excellent clinical and functional outcome.

Prolonged inpatient stay after upfront total laryngectomy is associated with overall survival.

OBJECTIVES: To investigate factors and complications associated with prolonged inpatient length of stay (LOS) in patients who receive total laryngectomy (TL), and to analyze its effect on short-term and long-term overall survival (OS). METHODS: The National Cancer Database (NCDB) was queried from 2004 to 2016 for patients with laryngeal cancer, who received TL within 60 days of diagnosis, and who had an inpatient LOS ≥1 night. Multivariable binary logistic regression and survival analyses on propensity score matched cohorts with Kaplan-Meier analysis and extended Cox regression were utilized. RESULTS: Eight thousand two hundred and ninety-eight patients from the NCDB were included. Median inpatient LOS was 8 days after TL (IQR: 7, 12). Prolonged LOS was defined as above the 75th percentile or 13 days or greater. On multivariable analysis, increasing patient age (OR 1.14 per 10 years, P = .003), female sex (OR 1.35, P < .001), and Charlson-Deyo comorbidity score of ≥2 compared to a score of 0 (OR 1.43, P < .001) were associated with prolonged LOS. Patients treated at high surgical case volume centers had a decreased likelihood for prolonged LOS (OR 0.67, P < .001). Ninety-day mortality increased over time in patients who stayed ≥13 days. Prolonged LOS was independently associated with worse OS on multivariable analysis (HR 1.40, 95% CI: 1.22, 1.61) in a matched cohort. CONCLUSIONS: Prolonged LOS after TL serves as a strong indicator for postoperative long-term mortality and may help identify patients who warrant closer surveillance. LEVEL OF EVIDENCE: 3.

Circulating immune parameters-based nomogram for predicting malignancy in laryngeal neoplasm.

BACKGROUND: Malignancy prediction remains important to preoperative diagnosis and postoperative follow-up in laryngeal neoplasm. AIM: To evaluate the circulating immune population and develop a nomogram for prediction of malignancy in patients with laryngeal neoplasm. METHODS: A primary cohort of 156 patients was divided into laryngeal benign lesion, premalignant lesion and malignant lesion groups. Peripheral blood from patients was measured by blood routine test and flow cytometry. A nomogram was developed and applied to a validation cohort containing 55 consecutive patients. RESULTS: Age, gender and seven circulating immune parameters exhibited significant differences between laryngeal benign lesion and premalignant lesion. The nomogram incorporated predictors, including gender, age, smoke index, proportions of monocytes, CD8+ T cells, CD4+ T cells, B cells and CD4/CD8+ T cell ratio. It showed good discrimination between laryngeal premalignant lesion and malignant lesion, with a C-index of 0.844 for the primary cohort. Application of this nomogram in the validation cohort (C-index, 0.804) still had good discrimination and good calibration. Decision curve analysis revealed that the nomogram was clinically useful. CONCLUSION: This novel nomogram, incorporating both clinical risk factors and circulating immune parameters, could be appropriately applied in preoperative individualized prediction of malignancy in patients with laryngeal neoplasm.

Myeloma of Laryngeal Cartilage: Literature Review and Case Study.

BACKGROUND: Myeloma of laryngeal cartilage (MLC) is a rare plasma cell neoplasm which has not been well characterized. However, it is an important differential diagnosis of laryngeal cartilage mass as it can indicate the presence of underlying systemic hematological diseases, such as multiple myeloma (MM), that is associated with poor prognosis. This article is the first of its kind and aims to educate clinicians on future diagnosis and management of similar cases. METHODS: Search of MLC was performed on the medical literature databases of Medline, PUBMED, and EMBASE. Additionally, institutional database at Gold Coast University Hospital Radiology Department was queried for relevant cases. Based on 16 cases that met the inclusion criteria, the etiology, epidemiology, clinical evaluation, investigations, management, and prognosis of MLC was summarized. RESULTS: Of all, 94% of MLC occur in males and 81% in those older than 60 years. It is more commonly a manifestation of systemic MM, rather than localized extramedullary plasmacytoma (EMP), 81% and 19% respectively. Additionally, 67% of laryngeal EMPs progress to MM within 3 years from initial diagnosis. Although treatments involving both local and systemic therapy were effective at relieving local symptoms, 39% of MLC patients died during the follow-up period-all of which were due to septicemia caused by secondary infections. CONCLUSION: Myeloma of laryngeal cartilage is a relatively rare condition that requires accurate diagnosis in order to promptly manage the potentially underlying systemic hematological disease. Currently, more case reports and analytical studies are required to provide evidence-based guidance on etiology, diagnosis, and management of this condition.

Prognostic value of the maximum standardized uptake value for the locoregional control in early glottic cancer.

PURPOSE: To evaluate the prognostic value of the pretreatment maximum standardized uptake value (SUVmax) for locoregional control (LRC) of early glottic cancer treated with primary radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 101 patients with T1-T2N0 glottic cancer treated with helical tomotherapy between 2013 and 2016. The clinical T-stages were T1 in 87 (86.1%) and T2 in 14 (13.9%) patients. The median total dose was 63 Gy (63-67.5 Gy) in 2.25 Gy per fraction. The survival outcomes were plotted using Kaplan-Meier curves. Receiver operating characteristic curves were used to assess the optimal SUVmax cut-off value for predicting locoregional recurrence. RESULTS: The median follow-up period was 58 months (range, 11 to 90 months). The 5-year overall survival (OS) and locoregional recurrence-free survival rates were 96.8% and 85.4%, respectively. The median pretreatment SUVmax of the primary tumor for all 101 patients was 2.3 (range, 1.1 to 9.1). The best cut-off value for SUVmax for predicting LRC was 3.3, with a sensitivity of 78.6% and specificity of 73.6%. Univariate analysis showed that T-stage, overall treatment time (≥43 days), and high SUVmax (≥3.3) were significant predictors of LRC. Multivariate analysis showed that LRC was independently affected by a high SUVmax (≥3.3) (hazard ratio = 5.505, p = 0.020). CONCLUSION: High pretreatment SUVmax (≥3.3) is a negative prognostic factor for LRC in early glottic cancer patients treated with primary radiotherapy.

Clinical Analysis of Laryngeal Spindle Cell Carcinoma.

AIMS: To investigate the clinical features, treatment, and outcomes of laryngeal spindle cell carcinoma (SpCC). METHODS: Between 2005 and 2014, patients from our hospital with SpCC of the larynx were retrospectively analyzed alongside patient data from the SEER database of America. RESULTS: A total of 11 patients with SpCC of the larynx were diagnosed and underwent surgery in our hospital. All patients were male and all tumors were located in the glottis. The 3- and 5-year OS rates were both 54.5%. In the SEER database, 148 patients were diagnosed with SpCC of the larynx. The 3- and 5-year OS rates were 72.8 and 63.2%, respectively. According to the comparison of propensity score-matched analysis, the OS was longer in squamous cell carcinoma (SCC) of the larynx (p < 0.0001). CONCLUSION: SpCC of the larynx is rare and typically originates in the glottis. Its prognosis is worse than that of laryngeal SCC, and surgery is a reasonable treatment strategy.

Non-squamous cell carcinoma diseases of the larynx: clinical and imaging findings / Carcinoma de células não escamosas da laringe: achados clínicos e de imagem

Abstract Introduction Squamous cell carcinoma is the most common laryngeal neoplasm and accounts for approximately 95% of all malignant neoplams of the larynx. However, various benign and malignant tumors and inflammatory diseases may affect the larynx. Objective The purpose of this study is to analyze the clinical and imaging findings of non-squamous cell neoplasms and inflammatory diseases of the larynx. Methods This retrospective study was conducted in 18 patients who were diagnosed with non-squamous cell carcinoma lesions of larynx at our institution between 2007-2017. Clinical symptoms, examination findings, imaging characteristics, histopathologic diagnosis and treatment modalities were analyzed. Results There were 9 malignant lesions (2 chondrosarcoma, 1 neuroendocrine tumor-atipical carcinoid, 1 Natural Killer/T-cell lymphoma, 1 diffuse large B-cell lymphoma, 3 plasmocytoma-multiple myeloma involvement, 1 adenocarcinoma metastasis), 3 benign neoplasms (chondroma, paraganglioma, lipoma), 2 tumor-like lesions (Brown tumor and inflammatory myofibroblastic tumor), 3 inflammatory lesions (Wegener granulomatosis, Behçet's disease and tuberculosis involvements), and 1 vascular malformation. The most common presenting symptom was hoarseness (66.6%). Paraganglioma was seen as hypervascular lesion on computed tomography and magnetic resonance imaging and showed intense tracer uptake on 68Gallium-DOTA-peptide PET/CT. Chondroid matrix calcifications were detected in chondroma and chondrosarcoma-grade 1. In patients with vascular malformation and lipoma, the typical imaging findings made it possible to diagnose. Conclusion Imaging studies may provide clues for diagnosis of non-squamous cell laryngeal lesions. Clinical and imaging findings and previous clinical history should be evaluated together in clinical management of laryngeal lesions.

Resumo Introdução O carcinoma de células escamosas é a neoplasia laríngea mais comum, representa aproximadamente 95% de todas as neoplasias malignas da laringe. No entanto, vários outros tumores benignos e malignos, e doenças inflamatórias, podem afetar a laringe. Objetivo O objetivo deste estudo é analisar os achados clínicos e de imagem de neoplasias de células não-escamosas e de doenças inflamatórias da laringe. Método Este estudo retrospectivo foi feito com 18 pacientes diagnosticados com lesões de carcinoma de células não escamosas da laringe em nossa instituição, entre 2007-2017. Foram analisados os sintomas clínicos, achados dos exames, características de imagens, diagnóstico histopatológico e modalidades de tratamento. Resultados Foram identificados 9 casos com lesão maligna (2 condrossarcomas, 1 tumor carcinoide neuroendócrino atípico, 1 linfoma de células T/NK, 1 linfoma difuso de grandes células B, 3 plasmocitomas com envolvimento de mieloma múltiplo, 1 metástase de adenocarcinoma, 3 neoplasias benignas (condroma, paraganglioma, lipoma), 2 lesões tumor like (tumor de Brown e tumor miofibroblástico inflamatório), 3 lesões inflamatórias (granulomatose de Wegener, doença de Behçet e tuberculose) e 1 malformação vascular. O sintoma mais comum foi a rouquidão (66,6%). O paraganglioma foi visto como lesão hipervascular na tomografia computadorizada e na ressonância magnética e mostrou intensa captação do traçador na PET/TC com 68Gálio-DOTA. Calcificações de matriz condroide foram detectadas no condroma e condrossarcoma grau 1. Em pacientes com malformação vascular e lipoma, os achados típicos de imagem tornaram possível o diagnóstico. Conclusão Estudos de imagem podem fornecer pistas para o diagnóstico de lesões laríngeas de células não escamosas. Achados clínicos e de imagem e histórico clínico prévio devem ser avaliados em conjunto no manejo clínico das lesões laríngeas.

Human papilloma virus-associated metachronous squamous cell carcinoma of the larynx and uterine cervix: Case report and review of the literature.

60 year old woman with a history of laryngeal carcinoma-HPV 16 positive, presents seven years later with an abnormal Pap smear. Cervical biopsy showed squamous cell carcinoma. Clinical stage was IB1. Patient underwent open radical hysterectomy and lymphadenectomy. Based on pathologic findings no adjuvant therapy was recommended. Uterine cervix carcinoma was also positive for HPV-16. There are no guidelines for cervical cancer screening in patients with laryngeal cancer and vice versa. Our recommendation is that patient with HPV-positive laryngeal cancer should be encouraged HPV vaccine as current guidelines, but more frequent screening, as recommended for women with specific co-morbid conditions, needs to be investigated. Research is needed to assess the role of screening for laryngeal cancer in women with cervical cancer and the effect of HPV vaccine on laryngeal cancer prevention.

Non-squamous cell carcinoma diseases of the larynx: clinical and imaging findings.

INTRODUCTION: Squamous cell carcinoma is the most common laryngeal neoplasm and accounts for approximately 95% of all malignant neoplams of the larynx. However, various benign and malignant tumors and inflammatory diseases may affect the larynx. OBJECTIVE: The purpose of this study is to analyze the clinical and imaging findings of non-squamous cell neoplasms and inflammatory diseases of the larynx. METHODS: This retrospective study was conducted in 18 patients who were diagnosed with non-squamous cell carcinoma lesions of larynx at our institution between 2007-2017. Clinical symptoms, examination findings, imaging characteristics, histopathologic diagnosis and treatment modalities were analyzed. RESULTS: There were 9 malignant lesions (2 chondrosarcoma, 1 neuroendocrine tumor-atipical carcinoid, 1 Natural Killer/T-cell lymphoma, 1 diffuse large B-cell lymphoma, 3 plasmocytoma-multiple myeloma involvement, 1 adenocarcinoma metastasis), 3 benign neoplasms (chondroma, paraganglioma, lipoma), 2 tumor-like lesions (Brown tumor and inflammatory myofibroblastic tumor), 3 inflammatory lesions (Wegener granulomatosis, Behçet's disease and tuberculosis involvements), and 1 vascular malformation. The most common presenting symptom was hoarseness (66.6%). Paraganglioma was seen as hypervascular lesion on computed tomography and magnetic resonance imaging and showed intense tracer uptake on 68Gallium-DOTA-peptide PET/CT. Chondroid matrix calcifications were detected in chondroma and chondrosarcoma-grade 1. In patients with vascular malformation and lipoma, the typical imaging findings made it possible to diagnose. CONCLUSION: Imaging studies may provide clues for diagnosis of non-squamous cell laryngeal lesions. Clinical and imaging findings and previous clinical history should be evaluated together in clinical management of laryngeal lesions.

Clinical outcome and comparison between squamous and non-squamous cell carcinoma of the larynx.

Background: The various pathological types of non-squamous cell carcinomas (nSCCs) of the larynx accounted for about 5% laryngeal malignancies, but the knowledge regarding these pathological behaviors, therapeutic models and prognostic factors was limited.Objectives: To investigate the clinical characteristics and the survival outcomes of nSCCs of the larynx.Material and methods: A total of 106 patients diagnosed with laryngeal nSCC between 2003 and 2014 were retrospectively investigated from a cohort of 4,796 patients with laryngeal malignancies.Results: Spindle cell carcinoma, malignant salivary gland carcinoma, neuroendocrine carcinoma, non-Hodgkin's lymphomas, and carcinosarcoma accounted for the majority of the nSCCs of the larynx. In laryngeal nSCCs (excluding non-Hodgkin lymphomas), there was no significant difference in overall survival (OS) by tumor subsite (p = .818), clinical-stage (p = .051) or T stage (p = .412), but the difference in OS by N stage was statistically significant (p = .001). Upon comparison of propensity score-matched groups, the OS was longer in SCCs of the larynx (p = .0004).Conclusions and significance: Primary nSCC of the larynx is rare, and its diagnosis depends on comprehensive immunohistochemical examination, as the clinical characteristics are non-specific compared with SCC. The overall prognosis of nSCC is relatively poor compared with that of SCC in the larynx.

The evaluation of pretreatment neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms / Avaliação da relação neutrófilo-linfócito e relação neutrófilo-linfócito derivadano pré-tratamento em pacientes com neoplasias laríngeas

Abstract Introduction: Systemic inflammatory biomarkers are promising predictive and prognostic factors for solid cancers. The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio are used to predict inflammation and used as biomarker in several malignancies. Objective: The purpose of this study was to demonstrate the diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio in patients with laryngeal neoplasms. Methods: A retrospective study was conducted on medical records involving 229 patients with benign, premalignant and malignant laryngeal neoplasms between 2002 and 2015. The diagnostic, predictive and prognostic role of neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were evaluated using uni- and multivariate analysis. Results: The neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were not statistically different between patients with benign, premalignant and malignant laryngeal neoplasms. Both neutrophil-lymphocyte ratio and derived neutrophil-lymphocyte ratio were predictive factors for stage, lymph node metastasis, and distant metastasis. Patients with high neutrophil-lymphocyte ratio value (≥4) had a poor prognosis when compared with patients with low neutrophil-lymphocyte ratio value (5 year, Overall Survival: 69.0% vs. 31.1%, p < 0.001; 5 year, disease free survival: 70.0% vs. 32.7%, p ˂ 0.001; 5 year, locoregional recurrence free survival: 69.7% vs. 32.0%, p < 0.001). Furthermore, neutrophil-lymphocyte ratio was an independent prognostic factor for 5 year: Overall survival (HR = 2.396; 95% CI 1.408-4.077; p = 0.001), Disease free survival (HR = 2.246; 95% CI 1.322-3.816; p = 0.006) and locoregional recurrence free survival (HR = 2.210; 95% CI 1.301-3.753; p = 0.003). Conclusion: Pretreatment neutrophil-lymphocyte ratio is a useful and reliable predictive and prognostic biomarker for patients with laryngeal carcinoma.

Resumo Introdução: Biomarcadores inflamatórios sistêmicos são fatores preditivos e prognósticos promissores para cânceres sólidos. A relação neutrófilo-linfócito e a relação neutrófilo-linfócito derivada são utilizadas para predizer a inflamação e como biomarcadores em várias malignidades. Objetivo: O objetivo deste estudo foi demonstrar o papel diagnóstico, preditivo e prognóstico da relação neutrófilo-linfócito e relação neutrófilo-linfócito derivada em pacientes com neoplasias laríngeas. Método: Foi realizado um estudo retrospectivo em prontuários médicos de 229 pacientes com neoplasias laríngeas benignas, pré-malignas e malignas entre 2002 e 2015. O papel diagnóstico, preditivo e prognóstico da relação neutrófilo-linfócito e relação neutrófilo-linfócito derivada foi avaliado por meio de análise uni- e multivariada. Resultados: A relação neutrófilo-linfócito e a relação neutrófilo-linfócito derivada não foram estatisticamente diferentes entre pacientes com neoplasias laríngeas benignas, pré-malignas e malignas. Ambas as relação neutrófilo-linfócito e relação neutrófilo-linfócito derivada foram fatores preditivos para o estágio, metástase linfonodal e metástase a distância. Pacientes com valor alto da relação neutrófilo-linfócito (≥ 4) apresentaram pior prognóstico quando comparados com pacientes com valor mais baixo da relação neutrófilo-linfócito (5 anos, Sobrevida Global: 69,0% vs. 31,1%, p < 0,001; 5 anos, sobrevida livre de doença: 70,0% vs. 32,7%, p < 0,001; 5 anos, sobrevida livre de recorrência loco-regional: 69,7% vs. 32,0%, p < 0,001). Além disso, a relação neutrófilo-linfócito foi um fator prognóstico independente para 5 anos: Sobrevida global (HR = 2,396; IC95% 1,408-4,077; p = 0,001), sobrevida livre de doença (HR = 2,246; IC95%: 1,322-3,816; p = 0,006) e sobrevida livre de recorrência loco-regional (HR = 2,210; IC95%: 1,301-3,753; p = 0,003). Conclusão: A relação neutrófilo-linfócito no pré-tratamento é um biomarcador preditivo e de prognóstico útil e confiável para pacientes com carcinoma de laringe.

A Multidisciplinary Team Guided Approach to the Management of cT3 Laryngeal Cancer: A Retrospective Analysis of 104 Cases.

The optimal treatment for T3 laryngeal carcinoma (LC) is still a matter of debate. Different therapeutic options are available: Transoral laser microsurgery (TLM), open partial horizontal laryngectomies (OPHLs), total laryngectomy (TL), and organ preservation protocols (radiation therapy (RT) or chemo-radiation (CRT)). This study aimed to retrospectively evaluate oncologic outcomes of 104 T3 LCs treated by surgery or non-surgical approaches from January 2011 to December 2016 at a single academic tertiary referral center. Each case was evaluated by a multidisciplinary team (MDT) devoted to the management of head and neck cancers. We divided the cohort into two subgroups: Group A, surgical treatment (TLM, OPHLs, TL) and Group B, non-surgical treatment (RT, CRT). For the entire cohort, two- and five-year overall survival (OS) rates were 83% and 56%, respectively. The two- and five-year disease-free survival (DFS) rates were 75% and 65%, and disease-specific survival rates were 93% and 70%, respectively. The N category was a significant independent prognosticator for OS (p = 0.02), whereas Group B was significantly and independently associated with DFS (HR 4.10, p = 0.006). Analyzing laryngo-esophageal dysfunction-free survival as an outcome, it was found that this was significantly lower in higher N categories (p = 0.04) and in cases that underwent non-surgical treatments (p = 0.002). Optimization of oncologic outcomes in T3 LCs may be obtained only by a comprehensive MDT approach, considering that different treatment options have heterogenous toxicity profiles and indications.