Laryngeal cancer in Finland: A 5‐year follow‐up study of 366 patients

Haapaniemi, Aaro; Koivunen, Petri; Saarilahti, Kauko; Kinnunen, Ilpo; Laranne, Jussi; Aaltonen, Leena‐Maija; Närkiö, Mervi; Lindholm, Paula; Grénman, Reidar; Mäkitie, Antti; Atula, Timo

doi:10.1002/hed.23834

Cited by 45 publications

(68 citation statements)

References 36 publications

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“…Although overall survival rate for our entire cohort of patients was excellent, it was concerning to see overall survival of patients with T2N0 (Stage II) cancers to be similar to those with Stage IV cancer (Figure 2). Similar unsatisfactory survival rates for patients with T2 cancers have been reported recently in a large nationwide study of unselected patients in Finland 68 . To better understand these results, detailed analysis of our relatively small number of T2 larynx cancer patients (N= 34) is underway.…”

Section: Discussionsupporting

confidence: 87%

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Wolf

Bellile

Eisbruch

et al. 2017

JAMA Otolaryngol Head Neck Surg

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The introduction of chemoradiation for advanced laryngeal cancer led to a major paradigm shift in treatment as an alternative to laryngectomy. Despite widespread adoption, survival rates have not improved and the original premise of matching neoadjuvant chemotherapy tumor response to determine subsequent treatment has not been followed. A unique approach incorporating a single cycle of neoadjuvant chemotherapy to select patients with advanced disease for either laryngectomy or concurrent chemoradiation was studied to determine if improved survival could be achieved. Design From 2002–2012, we treated an unselected cohort of 247 patients with laryngeal cancer in an academic institution. Interventions Limited disease patients (n=94) underwent endoscopic resection (n=33; 35%), radiation (n=50; 53%) or chemoradiation for deeply invasive T2 lesions (n=11; 12%). For advanced disease (n=153), neoadjuvant chemotherapy for treatment selection (n=71; 46%), concurrent chemoradiation (n=50; 33%) or primary surgery (n=32; 21%) was recommended. Outcomes Propensity for treatment selection in advanced patients was modeled using logistic regression. Overall (OS) and disease specific survival (DSS) were analyzed with Cox proportional hazards models stratified by propensity score. Median follow was 48 months. Results Five-year OS and DSS was 75% (95% C.I. 68–81%) and 83% (77–88%), respectively for the entire cohort. DSS was 92% (83–97%) for patients with Stage I, II and 78% (69–84%) for patients with Stage III, IV disease. For advanced disease patients, 5-year OS (and DSS) ranged from 78% (91%) for surgery to 76% (79%) for neoadjuvant bioselection and 61% (66%) for primary chemoradiation. Propensity-adjusted multivariable Cox models controlling for known prognostic factors showed DSS was significantly improved in the neoadjuvant group compared to definitive chemoradiation [Hazard ratio 0.48, 95%CI: (0.29, 0.80), p=0.005]. DSS for the definitive surgery group was significantly better compared to the neoadjuvant bioselection group, [Hazard ratio 0.34, 95%CI: (0.14, 0.82), p=0.02]. Larynx preservation was achieved in 65% of advanced patients. Conclusions Exceptional survival rates were achieved with a bioselective treatment approach utilizing a single cycle of neoadjuvant chemotherapy. Excellent survival rates were also achieved in patients selected for primary surgery and both were better than with concurrent chemoradiation suggesting that the optimal individualized treatment approach for patients with advanced laryngeal cancer has not yet been defined.

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Section: Discussionsupporting

confidence: 87%

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Wolf

Bellile

Eisbruch

et al. 2017

JAMA Otolaryngol Head Neck Surg

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“…Laryngeal carcinoma is predominantly a cancer of men and is rare in women 20, 43 . We adjusted other risk factors to avoid potential bias and found that the relative abundances of Streptococcus and Fusobacterium were reduced and enriched, respectively, in the larynx of male laryngeal cancer patients.…”

Section: Discussionmentioning

confidence: 99%

“…Laryngeal carcinoma is one of the most common malignancies of the head and neck, and squamous cell carcinoma is the most frequent histological type of laryngeal carcinoma, accounting for 98% of cases 19, 20 . The main risk factors for this cancer include tobacco smoking and alcohol consumption, and the roles of these risk factors have been consistently confirmed by a growing number of studies 21, 22 .…”

Section: Introductionmentioning

confidence: 99%

Alterations of microbiota structure in the larynx relevant to laryngeal carcinoma

Gong

Shi

Xiao

et al. 2017

Sci Rep

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The microbial communities that inhabit the laryngeal mucosa build stable microenvironments and have the potential to influence the health of the human throat. However, the associations between the microbiota structure and laryngeal carcinoma remain uncertain. Here, we explored this question by comparing the laryngeal microbiota structure in laryngeal cancer patients with that in control subjects with vocal cord polyps through high-throughput pyrosequencing. Overall, the genera Streptococcus, Fusobacterium, and Prevotella were prevalent bacterial populations in the laryngeal niche. Tumor tissue samples and normal tissues adjacent to the tumor sites (NATs) were collected from 31 laryngeal cancer patients, and the bacterial communities in laryngeal cancer patients were compared with control samples from 32 subjects. A comparison of the laryngeal communities in the tumor tissues and the NATs showed higher α-diversity in cancer patients than in control subjects, and the relative abundances of seven bacterial genera differed among the three groups of samples. Furthermore, the relative abundances of ten bacterial genera in laryngeal cancer patients differed substantially from those in control subjects. These findings indicate that the laryngeal microbiota profiles are altered in laryngeal cancer patients, suggesting that a disturbance of the microbiota structure might be relevant to laryngeal cancer.The human microbiota can be considered an organ composed of mixed species with functions that enable the construction of a polymicrobial assemblage 1, 2 . Microbial communities are abundant and relatively stable in the human body, which is constantly exposed to these microbial factors, and these communities play a fundamental role in regulating the health and physiology of the host via cooperative and competitive interactions [3][4][5] . Indeed, aberrations in the microbiota profiles play causative roles in the development of many clinical diseases, such as periodontitis, obesity, inflammatory bowel disease, diabetes mellitus, metabolic syndrome, atherosclerosis, and liver cirrhosis [6][7][8][9][10][11][12] . Specifically, differences in the relative abundance of certain microbial communities have been observed in cancer patients, indicating that disturbances in this multispecies synergy might be an important factor related to tumorigenesis [13][14][15] . Recently, the use of animal models possessing the same molecular pathway mechanisms observed in vivo has suggested that disruption of the microbiota can promote tumor initiation and development [16][17][18] . However, the mechanisms through which microbial factors influence susceptibility to laryngeal carcinoma remain elusive. Laryngeal carcinoma is one of the most common malignancies of the head and neck, and squamous cell carcinoma is the most frequent histological type of laryngeal carcinoma, accounting for 98% of cases 19,20 . The main risk factors for this cancer include tobacco smoking and alcohol consumption, and the roles of these risk factors have been consistentl...

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“…LSCC has three subsites: supraglottic, glottic, and subglottic tumors [4]. Glottic squamous cell carcinoma (GSCC) originates from the true vocal cords, and approximately 51% of LSCCs are glottic primary tumors, of which 85% to 95% are GSCC [5].…”

Section: Introductionmentioning

confidence: 99%

Matched-pair analysis of survival in patients with poorly differentiated versus well-differentiated glottic squamous cell carcinoma

Chen

Yu²,

Huang

et al. 2017

Oncotarget

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To compare survival outcomes between patients with poorly differentiated versus well-differentiated glottic squamous cell carcinoma (GSCC). Fifty-five patients with well-differentiated newly diagnosed GSCC were pair-matched to 55 patients with poorly differentiated GSCC according to age, sex, year of diagnosis, overall stage, treatment (surgery type, neck dissection, surgical margin, and chemoradiation), smoking, and alcohol use. Survival analysis was performed using Kaplan-Meier estimates, and matched-pair survival was estimated using the Cox proportional hazards regression model. Patients with well-differentiated GSCC had significantly better overall survival (OS) (P = 0.001), disease-specific survival (DSS) (P < 0.001), and disease-free survival (DFS) (P = 0.003) than patients with poorly differentiated GSCC. Moreover, matched-pair analysis indicated that increased differentiation was associated with a significantly reduced risk of overall death (HR, 0.18; 95% confidence interval [CI], 0.07–0.46), death owing to disease (HR, 0.16; 95% CI, 0.05–0.45), and disease recurrence (HR, 0.17; 95% CI, 0.07–0.41), and these risks were reduced approximately 4-fold, 3.7-fold, and 9-fold, respectively, after adjustment for cancer-associated variables. Survival differed significantly between the well-differentiated and poorly differentiated GSCC patients after adjustment for cancer prognosis-associated variables. Thus, identifying potential differences in the molecular characteristics between these two groups of patients would help to further stratify these patients and ensure appropriate individualized treatment decisions. Basing treatment strategies on the level of differentiation may improve survival.

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Laryngeal cancer in Finland: A 5‐year follow‐up study of 366 patients

Cited by 45 publications

References 36 publications

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Survival Rates Using Individualized Bioselection Treatment Methods in Patients With Advanced Laryngeal Cancer

Alterations of microbiota structure in the larynx relevant to laryngeal carcinoma

Matched-pair analysis of survival in patients with poorly differentiated versus well-differentiated glottic squamous cell carcinoma

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