Prognostic factors in T3,N0-1 glottic and transglottic carcinoma. A multifactorial study of 221 cases treated by surgery or radiotherapy.

Objective: To evaluate prognostic factors in patients with T3,N0-1 glottic and transglottic carcinoma treated in a single institution.
Design: Retrospective, nonrandomized case series.
Setting: Tertiary case referral centers, ambulatory or hospitalized care.
Patients: Two hundred twenty-one consecutive cases of stage III glottic or transglottic squamous cell carcinoma. Tumor stage was T3,N0,M0 in 167 cases and T3,N1,M0 in 54 cases.
Interventions: Surgery in 176 cases and radiotherapy in 45 cases.
Main Outcome Measures: Recurrences and survival (multivariate).
Results: Almost 7% of the patients who underwent surgery and 39.6% who had radiotherapy had local recurrences. Recurrences in the neck were seen in 16.4% of the patients who underwent surgery and in 10.5% of those who had radiotherapy. Distant metastases were diagnosed only in patients who underwent surgery (4.6%). The 5-year actuarial overall survival rates were 56.3% in the surgical group and 35.2% in the radiotherapy group (P = .007). Age involvement of pyriform sinus, N stage, and history of tracheostomy were independent prognostic factors for risk of death.
Conclusions: The presence of metastatic lymph nodes, age, and involvement of the pyriform sinus were the important prognostic factors in patients who underwent surgery. A small group of patients with T3,N0,M0 tumors could benefit from radiotherapy, with surgery reserved for recurrence.