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Positive initial margins associated with poor DFS following total laryngectomy
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Positive initial margins, even among patients with negative final margins, appeared associated with poorer DFS among patients with primary laryngeal squamous cell carcinoma who received total laryngectomy, according to recently published findings.
“Total laryngectomy is the definitive surgical treatment of advanced laryngeal cancer, and approximately 3,000 laryngectomies are performed in the United States each year, usually for the treatment of malignant disease,” Patrick Tassone, MD, resident at Thomas Jefferson University, and colleagues wrote.
“Whether used as initial treatment or as salvage treatment, the goal of total laryngectomy is to completely remove malignant tissue and achieve negative margins,” the researchers added. “In short, the association between positive frozen margins and oncologic outcomes in total laryngectomy is poorly understood.”
The researchers performed a retrospective cohort study of 237 patients who underwent total laryngectomy for squamous cell carcinoma from February 2008 to July 2016.
Researchers considered margins positive if they contained invasive carcinoma, carcinoma in situ or severe dysplasia.
A total of 225 patients (mean age, 63.9 years; 92% men) had negative final margins.
One hundred twenty-seven patients underwent primary total laryngectomy, whereas 98 received salvage total laryngectomy.
Mean follow-up was 29.3 months.
Forty patients (18%) had positive initial frozen margins, which included 21 (17%) who underwent primary total laryngectomy and 19 (19%) who received salvage total laryngectomy.
Salvage laryngectomy was associated with significantly worse DFS (HR = 3.35; 95% CI, 1.76-6.36), whereas primary total laryngectomy was not.
Univariable analysis showed positive lymph nodes, lymphovascular invasion, extracapsular nodal extension and adjuvant therapy were each associated with worse DFS among patients who underwent salvage total laryngectomy. However, none of these associations persisted on multivariable analysis.
Further, univariable analysis showed that positive nodes, lymphovascular invasion, extracapsular nodal extension and positive initial margins were all associated with DFS among patients who underwent primary total laryngectomy, but only positive initial margins were associated with DFS upon multivariable analysis (HR = 5.01; 95%CI, 1.55-16.2).
“Surgical margin status may be an important prognostic factor in head and neck cancer,” the researchers wrote. “This study suggests that positive initial frozen margins, even in patients with negative final margins, are associated with increased risk of local treatment failure in the context of primary total laryngectomy.” – by Andy Polhamus
Disclosures: The authors report no relevant financial disclosures.
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