Results
This study analyzed 128 cases of laryngeal squamous cell carcinoma, consisting of 118 men (92.2%) and 10 women (7.8%) with an average age of 59.32±7.62 and a median age of 60 years (Range: 41-82 years). Clinical staging showed 21 (16.4%) cases of stage II, 28 cases (21.9%) of stage III, and 79 cases (61.7%) of stage IV. Most tumors (75%) were located in the transglottic region, while the remaining 25% were in the supraglottic area. Tumor histologic grade was well-differentiated in 80 lesions (62.5%), moderately differentiated in 43 lesions (33.6%), and poorly differentiated in 5 lesions (3.9%) based on WHO classification. Positive lymph node involvement, extra-laryngeal extension, vascular invasion, and perineural invasion were present in 53(41.4%), 75 (58.6%), 22 (17.2%), and 35 (27.3%) of cases, respectively. During the follow-up period of 36 to 72 months, 48 patients (37.5%) survived, while the remaining 80 cases (62.5%) were deceased. Tumor budding was observed in 86 cases (67.2%), with high budding detected in 35 lesions (27.3%) and low budding in 51 lesions (39.8%). Cell nest size was classified as large in 18 lesions (14.1%), intermediate in 24 lesions (18.8%), small in 47 lesions (36.7%), and single cell in 39 lesions (30.5%) (Figure 1). A summarized outline of the clinical and histological findings can be found in Table 1.
We proceeded to examine how TB relates to various clinical and pathological factors. Our Chi-square test results indicated a significant correlation between TB and nodal involvement (P value=0.015), vascular invasion (P value=0.035), and mortality rate (P value=0.001). However, TB did not show any correlation with tumor location, histologic grade, clinical stage, extra-laryngeal extension, or perineural invasion. We also studied the correlation between TB scoring and other variables, which revealed a statistical significance between high TB and extra-laryngeal extension (P value=0.006), clinical stage (P value=0.011), and mortality (P value=0.001).
Furthermore, we analyzed the correlation of CNS subgroups with other variables. While the size of the nest did not impact perineural or vascular invasion, lesions with small nest size were significantly associated with the clinical stage (P value=0.047), extra-laryngeal extension (P value=0.015), and mortality rate (P value=0.001). The correlation of tumor budding and cell nest size with other variables can be found in Tables 2 and 3, respectively.
Our multivariate analysis identified TB, CNS, and clinical stage as independent prognostic factors for mortality rate, summarized in Table 4. Finally, we evaluated the disease-free survival of patients using the Kaplan-Meier method concerning tumor histological grade, clinical stage, presence or absence of tumor budding, and cell nest size. Apart from histologic grade, our data revealed a statistically significant difference between disease-free survival in each group (Figure 2).