Tassone P, et al. - In patients treated with total laryngectomy for squamous cell carcinoma, authors ascertained the correlation between disease-free survival and positive initial margins. Findings suggested an association of positive initial margins with worse disease-free survival among these patients, despite negative margins on final pathologic examination. In the context of primary laryngeal squamous cell carcinoma, there may be aggressive tumor behavior.

Methods

• Authors in this retrospective cohort study (conducted at a tertiary care center) reviewed the records of 237 consecutive patients treated with total laryngectomy for squamous cell carcinoma from February 2008 to July 2016 for demographic characteristics, disease staging, pathologic markers, and outcomes.
• They considered the margins to be positive if they contained invasive carcinoma, carcinoma in situ, or severe dysplasia.
• They performed the data analysis from March to June 2018.
• For squamous cell carcinoma, laryngectomy was undertaken by all patients.
• They evaluated the variables associated with disease-free survival using a univariable and multivariable Cox proportional hazards model.

Results

• As per data, among all 225 patients (184 [92%] male; mean age, 63.9 years; range, 30-92 years) who underwent total laryngectomy and had negative final margins, 127 patients underwent primary total laryngectomy and 98 underwent salvage total laryngectomy, with mean (SEM) follow-up of 29.3 (1.8) months.
• In 40 of 225 patients (18%), initial frozen margins were positive, with positive initial margins occurring in 21 of 127 patients who underwent primary total laryngectomy (17%) and in 19 of 98 patients who underwent salvage total laryngectomy (19%).
• On multivariable analysis they noted an association of only salvage laryngectomy with significantly worse disease-free survival (hazard ratio [HR], 3.35; 95% CI, 1.76-6.36).
• Results demonstrated that among 98 patients who underwent salvage total laryngectomy, upon univariable analysis, positive lymph nodes, lymphovascular invasion, extracapsular nodal extension, and adjuvant therapy were correlated to worse disease-free survival, but no factors were significant on multivariable analysis.
• Among 127 patients who underwent primary total laryngectomy, an association of positive nodes, lymphovascular invasion, extracapsular nodal extension, and positive initial margins with worse disease-free survival was seen; nonetheless, only positive initial margins were correlated to significantly worse disease-free survival on multivariable analysis (HR, 5.01; 95% CI, 1.55-16.2).