Page 59 - Portuguese Journal - SPORL - Vol 61. Nº2

Table 4
Impact on the prognosis of patients with downstaging of the T category

cT cN Stage pT pN Stage Karnofsky Conditions for conservative treatment Location of the tumor Tumor size (> measurement) Invasion of the internal surface of the thyroid cartilage Laryngeal mobility Previous tracheostomy Dysphagia Proposed treatment

Age index

53 cT4cN0 pT3pN0 90% Yes Glottic 3,5 cm Yes Immobile Yes No TL
80 cT4cN0 pT3pN0 80% No Supraglottic 2,4 cm Yes Immobile Yes Yes TL
Organ
60 cT4cN0 pT3pN0 90% Yes Supraglottic 2 cm No Normal No No Preservation
Organ
51 cT4cN1 pT3pN0 80% Yes Supraglottic 3,6 cm Yes Normal No No Preservation
69 cT4cN2 pT3pN2 90% No Supraglottic 2,5 cm Yes Poorly mobile No No TL
57 cT4cN2 pT3pN2 90% Yes Supraglottic 3,4 cm No Immobile No No TL
Organ
62 cT3cN0 pT2N0 90% Yes Glottic 1,2 cm No Normal No No
Preservation
Organ
57 cT3cN0 pT2N0 90% Yes Glottic 2 cm Yes Poorly mobile No No Preservation
61 cT3cN1 pT2N3 80% Yes Hypopharyn 3,5 cm No Normal Yes No TL

56 cT3N0 pT2cN1 80% Yes Glottic 1,7 cm No Normal No No Organ
Preservation
75 cT4cN2 pT2pN3 70% No Supraglottic 3 cm No Normal No Yes TL
Organ
46 cT3cN2 pT1pN0 80% Yes Supraglottic 4,5 cm No Normal No No
Preservation
Organ
78 cT2cN1 pT1pN0 90% Yes Hypopharyn 2,6 cm No Normal No Yes Preservation
Discussion of the thyroid cartilage. The preepiglottic and
3
In the present study, discrepancy between the paraglottic spaces, both rich in adipose tissue,
clinical and pathological staging of cancer of blood, and lymphatic vessels, are important
the larynx and hypopharynx was frequently routes for the submucosal dissemination
observed and was similar to that reported of laryngeal carcinoma. Invasion of the
8
in the literature (between 18% and 50%); it preepiglottic space occurs through the
was greater for the N category than for the fenestrations in the epiglottic cartilage in the
T category. 1,5,7 In fact, approximately 20% of case of supraglottic tumors (especially those
the patients who were clinically classified of the epiglottis), by upward dissemination
as N0 had positive lymph nodes (N+) in from the anterior commissure (in glottic
the pathological staging. Although the pN tumors), or by invasion of the paraglottic space
classification is usually the factor that best in cases where there is no anatomic barrier/
correlates with survival , in the present study, fibrous layer separating the two spaces.
8,9
5,7
the change in the N classification did not have In turn, the invasion of the paraglottic space
an impact on the overall outcomes. can lead to tumor dissemination that may be
The T component of the 8 edition of the TNM posterior (cricoarytenoid joint, hypopharynx,
th
classification included T3 tumors that exhibit and esophagus), downward (to the subglottis),
distinct patterns of invasion and behavior in anterior (to the extra-laryngeal tissues
the same category. Tumors are classified as through the hiatus between the thyroid and
3
T3 when they are associated with vocal cord cricoid cartilages), or, less frequently, upward
fixation or invade the pre-epiglottic space, (to the preeepiglottic space). It is thus
9
paraglottic space, and/or the internal surface essential to identify tumor invasion in these

Volume 61 . Nº2 . June 2023 201