Larynx

--Shah JP, Karnell LH, Hoffman HT, Ariyan S, Brown GS, Willard EF, Flass AG, Goepfert H, Ossof RH, Fremgen AM. Patterns of care of cancer of the larynx in the United States. Arch Otolaryngol Head Neck Surg 1997; 123:475-483. (!)

This report provides case characteristics, diagnostic procedures, treatment patterns, and outcomes for laryngeal squamous cell carcinoma using the largest series of patients to date (16,936 cases diagnosed in 1980-1985 and 1990-1992) to be accrued in a Patient Care Evaluation study. There was a slight increase across these years in stage IV disease and in the use of radiation therapy (with or without surgery and/or chemotherapy). Overall diversity of management of this disease (by site and stage) was apparent. Five-year, disease-specific survival rates indicated a large difference between modified groupings of the T and N classifications, separating stage III and IV cases into localized disease (87.5% for T1-2, 76.0% for T3-4 cases) and regional metastasis (46.2%). Regardless of improvements in entering data in hospital records (most commendably, staging), more rigorous standards are needed. The small increase in advanced-stage patients indicates that efforts toward early detection have not been successful. The rise in radiation therapy perhaps reflected an increased use of non-surgical treatment for early-stage patients and organ-sparing radiochemotherapy protocols for advanced-stage patients. Regrouping stage III and IV cases into localized disease versus regional metastasis appears to predict survival with more accuracy; ongoing refinements of the AJCC staging scheme will hopefully improve this cancer's classification.

--Hoffman HT, Karnell LH. Laryngeal cancer. In: Steele GD, Jessup JM, Winchester DP, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1995. Atlanta, GA: American Cancer Society, 1995: 84-99.

Data were received on 9,101 laryngeal cancer cases from 1986-1987 and 8,139 cases from 1992. These data represent approximately 39% and 65% of all laryngeal cancer diagnosed in the United States in1986-1987 and 1992, respectively. Lower-income patients, ethnic minorities, women, and patients aged 40-59 years presented more frequently with advanced-stage laryngeal cancer. Patients with glottic laryngeal cancers received treatment earlier in the course of their disease than patients with supraglottic or subglottic laryngeal cancers. A small shift toward more-advanced stage at diagnosis for all laryngeal cancer cases was noted. This shift may reflect more thorough staging techniques. Tumor grade paralleled stage to a greater extent for glottic cancers than for supraglottic cancers. Within each stage group, glottic cancer is more curable than supraglottic cancer. The number of open procedures for early-stage cancers declined as a result of expanding use of endoscopic excision of suitable lesions and increased use of irradiation. The study indicated an increased use of surgical treatment (alone or with other modalities) and an increased use of combined treatment with radiation and chemotherapy. The data demonstrated substantially better survival rates for patients who underwent surgery than for those who underwent radiation therapy, although these findings may result from selection bias.

--Shah JP, Menck HR, Karnell LH, Zuber-Ocwieja KE. AJCC staging statistics for laryngeal cancer. The (NCRA) Abstract September 1993; 27-28.

Two Calls for Data yielded 34,037, 44,234, and 64,780 cases for 1985, 1988, and 1990, respectively. These laryngeal cancer cases are a convenience sample representing approximately 24%, 28%, and 39% of all laryngeal cancers in the United States for 1985, 1988, and 1990, respectively. Histologic grade, anatomic subsite, sex, and age group appeared to be strongly associated with AJCC stage. The ratio of early stage to advanced stage disease (stage 0+I/II+IV) was inversely related to grade. The ratios for grades 1, 2, 3, and 4, as well as unknown grade were 1.9, 0.8, 0.4, 0.6, and 2.1, respectively. Cases diagnosed in the glottis had the most favorable stage distribution. The ratios of early to advanced stages for the glottis, supraglottis, and other or unknown subsite were 2.3, 0.4, 0.5, and 0.3, respectively. Males were reported with more favorable stage distribution. The early to advanced stage disease ratios were 1.1 for males and 0.8 for females. Age was directly related to stage of disease. The older patients were reported with earlier stage disease. The early-to-advanced stage disease ratios for ages 0-64, 65-74, and 75 and older were 0.9, 1.1, and 1.4, respectively.

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