Outcomes Following Transoral Laser Microsurgery for T1b and T2a Glottic Squamous Cell Carcinoma With and Without Anterior Commissure Involvement: A Retrospective Chart Review

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Importance There is a limited understanding of anterior commissure (AC) involvement in glottic squamous cell carcinoma (SCC), particularly when comparing T1b, T2a with AC involvement (T2AC), and T2a without AC involvement (T2noAC). Objective The aim of this study was to compare oncological and functional outcomes in T1b, T2AC, and T2noAC glottic SCC following transoral laser microsurgery (TLM). Design Retrospective chart review. Setting The Queen Elizabeth II Health Science Centre (Halifax, Nova Scotia) from January 1, 2002, to December 31, 2022. Intervention and Exposures A retrospective chart review was completed using prospectively-collected data for patients treated with TLM for T1b and T2a glottic SCC. Exclusion criteria included previous treatment for a laryngeal cancer and T2b glottic SCC. Main Outcome Measures Oncological outcomes were assessed using margin status, local control (LC), disease-specific survival (DSS), overall survival (OS), and laryngeal preservation (LP). Functional outcomes were measured using the abbreviated Voice Handicap Index-10 (VHI-10). Results In total, 117 patients were included (T1b = 46, T2AC = 53, T2noAC = 18). Positive margins were higher in the T2AC group (15.1%) than in T1b (4.3%) and T2noAC (5.6%; P = .208). At 5 years, there were no significant differences in LC (T1b = 80.8%, T2AC = 70.3%, T2noAC = 76.2%; P = .26), DSS (T1b = 100%, T2AC = 90.2%, T2noAC = 93.8%; P = .45), OS (T1b = 88.3%, T2AC = 76.1%, T2noAC = 93.8%; P = .69), or LP (T1b = 94.3%, T2AC = 92.1%, T2noAC = 94.4%; P = .74). Significant improvements in VHI-10 scores from the pre- to postoperative period were only noted in the T1b cohort, at the 6 months ( P = .017) and the 12 months ( P = .00143). Conclusions No significant differences in both oncological and functional outcomes were noted between T1b, T2AC, and T2noAC glottic SCCs. Further stratifying based on the degree and pattern of AC involvement with larger sample sizes may provide important prognostic factors. Relevance This study highlights that T2 glottic SCCs with normal vocal fold mobility are a heterogenous group, and it may be beneficial to further stratify these cancers according to AC involvement, particularly when considering TLM.