Neck Active Monitoring After Partial Laryngectomy for cT2N0M0 True Vocal Cord SCC: A 10-Year STROBE Analysis.

Abstract

To evaluate 10-year nodal outcome of active monitoring of the neck for cT2N0M0 true vocal cord (TVC) squamous cell carcinoma (SCC) after frontline partial laryngectomy (PL). Retrospective observational study adhering to the STROBE guideline. French academic tertiary referral care center. Inception cohort of 81 isolated and untreated cT2N0M0 TVC SCC consecutively managed between 1983 and 2013 with frontline PL and active monitoring of the neck. 85% of patients were followed until death or for at least 10 years. Main endpoint was 10-year actuarial nodal control analysis. Secondary endpoints were the search for potential variables increasing the risk for nodal recurrence, management of nodal recurrence, and analysis of the oncologic consequences of nodal recurrence. The significance threshold was set at p < 0.005. The 10-year actuarial nodal control estimate was 90% with salvage treatment, yielding a 99% overall nodal control rate. On univariate analysis, none of the variables assessed significantly statistically increased the risk for nodal recurrence. The 10-year actuarial estimate of distant metastasis was 0% in patients with nodal control as compared with 35% in patients with nodal recurrence (p < 0.0001). The 10-year actuarial survival estimate was 0% in patients with nodal recurrence as compared with 67% in patients with nodal control (p < 0.0001). Among the 37 patients who died, uncontrolled SCC was the cause of death in 33% of patients who had a nodal recurrence and 3% of those who did not. Active monitoring of the neck for cT2N0M0 TVC SCC managed with PL, although not detrimental in terms of overall nodal control, is impaired by the negative oncological impact of nodal recurrence.