Laringeal kanserde evre, kronik obstrüktif akciğer hastalığı ve ikinci primer malignitelerin prognostik etkisi: tek merkezli retrospektif kohort çalışması

Öz

Amaç: Laringeal kanserde (LK) tümör evresi ve komorbid durumlar, iyi bilinen prognostik faktörlerdir; ancak bu değişkenlerin sağkalım üzerindeki kombine etkisi gerçek yaşam verilerinde yeterince kapsamlı şekilde araştırılmamıştır. Bu çalışmanın amacı, LK hastalarında tümörün evresi, komorbiditeler ve ikinci primer malignitelerin (İPM) uzun dönem sağkalım üzerine etkilerini değerlendirmektir. Gereç ve Yöntemler: 2010–2023 yılları arasında kurumumuzda tedavi edilip takip edilen, histopatolojik olarak doğrulanmış laringeal skuamöz hücreli karsinom tanılı 130 hasta retrospektif olarak incelendi. Sağkalım analizleri Kaplan–Meier yöntemi ile yapıldı; prognostik faktörler Cox orantısal risk regresyon modeli kullanılarak değerlendirildi. Özellikle komorbiditelerin, KOAH’ın ve İPM’lerin prognostik etkileri araştırıldı. Bulgular: Tüm kohortta ortalama genel sağkalım (OS) 87,1 ay olarak hesaplandı (%95 GA: 72,2–101,9). Metastatik hastalığı bulunanlarda OS anlamlı derecede daha kısa bulundu (ortalama: 10,2 ay; p < 0,001). En az bir komorbiditesi olanlarda OS 70,2 aya düşmüştü (p = 0,004). Metastatik hastalık, mortalite riskinde 4,9 kat artış ile ilişkiliydi (HR = 4,92; p < 0,001). SPM, 15 hastada (%11,5) saptandı ve üç hasta (%2,3) SPM nedeniyle kaybedildi. Çok değişkenli analizde, SPM (HR = 2,37; %95 GA: 1,48–3,79; p = 0,002) ve KOAH (HR = 1,88; %95 GA: 1,22–2,90; p = 0,008) bağımsız olarak olumsuz sağkalım öngördürücüleri olarak belirlendi. Sonuç: Tümör evresi, komorbiditeler ve ikinci primer maligniteler, laringeal kanserli hastalarda sağkalımı hem bağımsız hem de sinerjistik olarak etkilemektedir. Bu bulgular, onkolojik tedaviyi komorbidite yönetimi ve dikkatli izlemle entegre eden multidisipliner bir yaklaşımın önemini ortaya koymaktadır.

Anahtar Kelimeler

• laringeal kanser
• genel sağkalım
• ikinci primer malignite
• tümör evresi

Prognostic impact of stage, chronic obstructive pulmonary disease and second primary malignancies in laryngeal cancer: a single-center retrospective cohort study

Öz

Aim: Tumor stage and comorbid conditions are well-established prognostic factors in laryngeal cancer (LC); however, their combined impact on survival has not been comprehensively evaluated in real-world settings. This study aimed to assess the effects of tumor stage, comorbidities, and second primary malignancies (SPMs) on long-term survival in patients with LC. Material and Methods: We retrospectively analyzed data from 130 patients with histologically confirmed laryngeal squamous cell carcinoma who were treated and followed at our institution between 2010 and 2023. Survival outcomes were assessed using the Kaplan--Meier method and Cox proportional hazards regression. The prognostic impact of comorbidities, COPD, and SPMs was specifically evaluated. Results: The mean overall survival (OS) for the entire cohort was 87.1 months (95% CI: 72.2--101.9). Patients with metastatic disease had significantly shorter OS (mean: 10.2 months; p < 0.001), and those with at least one comorbidity had a reduced OS of 70.2 months (p = 0.004). Metastatic disease was associated with a 4.9-fold increased risk of mortality (HR = 4.92; p < 0.001). SPMs occurred in 15 patients (11.5%), and three patients (2.3%) died due to SPMs. In multivariate analysis, both SPMs (HR = 2.37; 95% CI: 1.48--3.79; p = 0.002) and COPD (HR = 1.88; 95% CI: 1.22--2.90; p = 0.008) were identified as independent predictors of worse survival. Conclusion: Tumor stage, comorbidities, and second primary malignancies independently and synergistically impact survival outcomes in patients with laryngeal cancer. These findings underscore the importance of a multidisciplinary care model that integrates oncologic treatment with comorbidity management and vigilant follow-up.

Anahtar Kelimeler

• laryngeal cancer
• overall survival
• second primary malignancy
• tumor stage

Kaynakça

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide. CA Cancer J Clin. 2021;71(1):209-49.
2. Conway DI, Hashibe M, Boffetta P, et al. Lifestyle risk factors for oral cancer. Oral Oncol. 2015;51(6):819-25.
3. Güneri P, Unlu T, Simsek G. Laryngeal carcinoma epidemiology in Türkiye. Turk Patoloji Derg. 2015;31(2):48-55.
4. Megwalu UC, Desai S, Doucette JR, et al. Trends in laryngeal cancer outcomes. Laryngoscope. 2022;132(5):1079-84.
5. Groome PA, Schulze KM, Mackillop WJ, et al. Survival by stage in laryngeal cancer. Head Neck. 2011;33(4):458-68.
6. Forastiere AA, Goepfert H, Maor M, et al. RTOG 91-11: organ preservation in laryngeal cancer. N Engl J Med. 2003;349(11):2091-8.
7. Datema FR, Ferrier MB, de Jong RJB, Schornagel JH, van der Laan BFAM. Comorbidity in head and neck cancer prognosis. Cancer. 2011;117(11):2423-32.
8. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in cancer. J Clin Oncol. 2004;22(3):610-8.

9. Sanabria A, Upadhyaya A, Moon J, Carroll W. Head and neck cancer multimodality treatment outcomes. Head Neck. 2007;29(9):1090-100.
10. Slaughter DP, Southwick H, Smejkal W. “Field cancerization” in oral epithelium. Cancer. 1953;6(5):963-8.
11. León X, Orús C, Suárez C, et al. Second primary tumours after head and neck cancer. Oral Oncol. 2013;49(5):373-8.
12. Simard EP, Engels EA, Anderson WF. Survival trends in head and neck cancer. Cancer. 2014;120(9):1290-314.
13. Piccirillo JF, Tierney RM, Costas I, et al. ACE-27 comorbidity index for head and neck cancer. Ann Otol Rhinol Laryngol. 2004;113(7):581-6.
14. Warren S, Gates O. Multiple primary malignant tumours: review of literature. Am J Pathol. 1932;8(3):161-76.
15. Cohen EE, Lingen MW, Vokes EE. Multimodality treatment in head and neck cancer. J Clin Oncol. 2014;32(35):3362-7.
16. Farlow JL, Keslar MH, Leclair CC, et al. Hoarseness as early symptom of laryngeal cancer. JAMA Otolaryngol Head Neck Surg. 2022;148(11):1031-8.
17. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care in metastatic non-small cell lung cancer. N Engl J Med. 2010;363(8):733-42.
18. Duchateau CS, van Dijk BAC, Langendijk JA. COPD effect on radiotherapy tolerance. Radiother Oncol. 2015;116(2):229-35.
19. Agrawal N, Zhang J, Bauman JE, et al. Radiotherapy complications in head and neck cancer patients with COPD. Lancet Oncol. 2017;18(6):e310-20.
20. Du E, Trotti AM, Xia P, et al. COPD and survival in head and neck cancer patients. Oral Oncol. 2022;134:106108.
21. Dort JC, Trites JRM, et al. Non-cancer mortality in head and neck cancer with COPD. JAMA Otolaryngol Head Neck Surg. 2020;146(9):845-53.
22. Wulff NB, Primdahl H, Johansen J, et al. Sex differences in tumor biology and outcome in head and neck cancer. Acta Oncol. 2015;54(6):797-802.
23. Paget Bailly S, Fabre A, Berthiller J, et al. Alcohol, tobacco and cancer risk. Eur J Cancer Prev. 2012;21(6):550-66.
24. van Monsjou HS, Langendijk JA, de Boer MF, et al. Secondary malignancies after head and neck cancer. Oral Oncol. 2013;49(7):878-85.
25. Krabbe CA, Chmura SJ, Patel CG, et al. PET-CT detection of second primaries in head and neck cancer. Eur J Nucl Med Mol Imaging. 2017;44(10):1722-33.
26. Khuri FR, Lee JJ, Lippman SM, et al. Impact of smoking cessation on second primary tumors. J Clin Oncol. 2001;19(3):728-35.