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Relevance of Pathologic Stage to Survival and Therapy

John W. Decker, MD; John C. Price, MD; Jerome C. Goldstein, MD

Arch Otolaryngol Head Neck Surg. 1986;112(11):1163-1167.

Abstract
• Sixty-seven laryngectomies performed for stage Ill and stage IV laryngeal carcinoma were reviewed. Stage III disease was managed by surgery alone. Treatment of stage IV disease was divided equally between surgery only and surgery plus radiotherapy. Five-year survival rates by clinical stage were 73% for stage III and 39% for stage IV. Clinical underestimation of disease occurred in 25% of stage III lesions. Unrecognized cartilage invasion and nodal disease occurred with equal frequency. Survival rates computed on the basis of pathologic staging were 91% for stage III and 41% for stage IV. Patients with stage IV disease who were treated with surgery alone had a 28% survival rate, while those receiving both radiotherapy and surgery had a 56% survival rate. In our opinion, surgical pathologic staging more accurately predicts survival than does clinical staging. Surgery alone appears to be adequate therapy for pathologic stage III laryngeal cancer. Addition of radiotherapy significantly improves survival in stage IV disease.

(Arch Otolaryngol Head Neck Surg 1986;112:1163-1167)

Author Affiliations
From the Divisions of Otolaryngology-Head and Neck Surgery, Albany (NY) Medical College and Albany (NY) Veterans Administration Medical Center. Dr Decker is now in private practice, St Cloud, Minn; Dr Price is with the Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, and Loch Raven Veterans Administration Hospital, Baltimore; and Dr Goldstein is with the American Academy of Otolaryngology-Head and Neck Surgery, Washington, DC.

Footnotes
Accepted for publication June 19, 1986.

Read before the American Society for Head and Neck Surgery, Palm Beach, Fla, May 7, 1986.

Reprint requests to The Johns Hopkins Hospital, Carnegie 469, 600 N Wolfe St, Baltimore, MD 21205 (Dr Price).

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