The potential risk of vessel infiltration and cervical lymph node metastasis in hypopharyngeal superficial squamous cell carcinoma: a retrospective observational study

Conclusion: The depth of hypopharyngeal superficial cancer may predict vessel infiltration and potential risk of cervical lymph node metastasis. Objectives: To elucidate the histopathological predictors of vessel infiltration and the risk of regional lymph node metastasis in hypopharyngeal superficial cancer. Methods: This study included 31 lesions from 30 patients who had undergone transoral en bloc resection in the hospital. Patients with intraepithelial neoplasia or muscular invasion were excluded. Patient characteristics, nodal status, state of vessel infiltration, state of perineural invasion, histopathological parameters, and post-operative cervical lymph node recurrence were retrospectively examined. The histopathological parameters measured were tumor diameter and the following three parameters: tumor thickness, depth from the mucosal surface, and depth from the basement membrane. Correlations between histopathological parameters and state of vessel infiltration were statistically analyzed. Results: Of the 31 lesions examined, four had vessel infiltration. Three of the four lesions with vessel infiltration had regional lymph node metastasis as well as subsequent lymph node metastasis. Lesions with vessel infiltration were significantly deeper than those without. In contrast, there was no significant difference in lesion diameters. In addition, there was no correlation between the depth and the diameter of the lesion.     

Glutathione S-transferase pi expression in nasopharyngeal cancer

BACKGROUND: Glutathione S-transferase pi (GST-pi) is an enzyme that catalyzes the conjugation of electrophilic substrates and prevents oxidative damage. Although GST-pi expression has been analyzed in many cancers, the significance of GST-pi expression in nasopharyngeal cancer (NPC), a tumor with a high treatment failure rate, is still unclear. OBJECTIVE: To elucidate the significance of GST-pi expression in NPC. DESIGN: Evaluation of GST-pi expression in NPC tissue specimens and determination of its relationship with tissue iron (a pro-oxidant) and clinicopathological factors in NPC. MATERIALS AND METHODS: Immunohistochemical expression of GST-pi was carried out in 55 NPC and 4 normal nasopharyngeal tissue sections. Eleven nasopharyngeal biopsy specimens (4 normal and 7 NPC) were analyzed for tissue iron levels. The expression of GST-pi in NPC was correlated with corresponding tissue iron levels. The relationships between GST-pi expression with sex, race, tumor stage, cervical nodal status, and clinical staging were also analyzed. RESULTS: Glutathione S-transferase pi immunoreactivity was observed in all NPC sections, with the percentage of immunopositive cells ranging from 1.0% to 72.0%. Tissue iron levels were significantly higher in the NPC tissues compared with normal tissues (P =.001). A direct correlation was observed between GST-pi expression and total and nuclear iron levels in NPC (P =.01 and P =.047, respectively). A significant association was also observed between GST-pi expression and cervical nodal disease (P =.007). CONCLUSIONS: Nasopharyngeal tumor cells may respond to pro-oxidant conditions by modulating intracellular antioxidant defense. Glutathione S-transferase pi expression appears to be associated with lymphogenous metastasis in NPC.     

Markers for nodal metastasis in head and neck squamous cell cancer

OBJECTIVE: To identify markers that are relevant as predictors of lymph node metastasis in head and neck squamous cell cancer. DESIGN: Expression of p53, Rb, cyclin D1, E-cadherin, and epithelial cell adhesion molecule was examined using immunohistochemical analysis and traditional histological parameters, and the correlation of these markers with the histologically verified presence of regional metastases was determined. SUBJECTS: The study sample comprised 121 patients with head and neck squamous cell cancer from whom paraffin-embedded material of primary tumors was used. RESULTS: Lymph node metastasis was correlated with the loss of expression of Rb (P =.04) and marginally correlated with the loss of expression of E-cadherin (P =.06). If the results are broken down to subsites, loss of E-cadherin expression in oral cancer (P =.04) and absence of eosinophilic infiltration in laryngeal cancer (P =.003) correlated with nodal metastasis. None of the other markers correlated. A combination of relevant parameters did not result in a much stronger correlation. CONCLUSIONS: The expression of the investigated genetic markers and histopathological features of primary tumors can supply limited information on the metastatic behavior of tumors. Although the use of markers for regional metastasis would be a welcome additional tool, these results do not warrant the use of these parameters for clinical decision making concerning the treatment of the neck in patients with head and neck squamous cell cancer.     

鼻咽癌局部扩散与远处转移的相关性

目的:探讨鼻咽癌局部和区域扩散与远处转移的相关性。方法:分析204例鼻咽癌初治患者的临床资料(其中放疗后无瘤生存≥5年者101例,为无瘤组;放疗后远处转移者103例,为转移组),重新阅读其治疗前CT片,确定局部扩散范围和方式,并进行单因素和Cox模型分析。结果:单因素分析表明,鼻窦侵犯,颅底破坏,脑神经损害,咽旁间隙侵犯程度,颈淋巴结转移侧数、个数、大小及活动度,临床分期,T分期与N分期均具有统计学意义(均P<0.05);多因素分析只显示鼻窦侵犯,脑神经损害,颈淋巴结转移侧数、个数和大小,临床分期具有统计学意义;对局部扩散各种因素与区域扩散相关性分析显示,无论是局限性病变,还是颅底、咽旁间隙等扩散,转移组并区域淋巴结转移及其转移程度(N2,3)均明显高于无瘤组(P<0.05或P<0.01)。结论:区域淋巴结转移及其程度是鼻咽癌放疗后远处转移最主要、最恒定的因素,原发灶局部扩散主要是通过区域淋巴结转移来影响远处转移。     

Clinicopathological factors related to cervical lymph node metastasis in a patient with carcinoma of the oral floor

CONCLUSION: Tumors developing into the muscle layer and tumor thickness > or =5 mm are the most important risk factors associated with nodal metastasis. OBJECTIVE: It is necessary to identify the risk factors associated with cervical metastasis in patients with oral floor cancer to reveal the role of elective neck dissection for oral floor cancer. PATIENTS AND METHODS: Forty-eight patients with oral floor cancer were retrospectively analyzed for a correlation between clinicopathologic factors and cervical lymph node metastasis using Fisher's exact test and a logistic regression test. RESULTS: Univariate analysis showed significantly positive correlations for growth type, mitosis, perineural invasion, vascular invasion, lymphatic invasion, depth, thickness, and infiltration growth ratio. Multivariate analysis had a significantly positive correlation with nest formation and depth in all patients, and with thickness in patients with T1 or T2. In patients with bilateral cervical lymph node metastasis, lymph node metastasis was significantly positively correlated with perineural invasion.     

Significance of the involvement of parapharyngeal space cervical nodes and cranial nerves in nasopharyngeal carcinoma

Two hundred cases of nasopharyngeal carcinoma (NPC) admitted to this department from Feb. 1985 to May. 1988 were analysed according to the CT scanning and clinical findings of the primary lesions prior to radiotherapy. The results showed that involvement of parapharyngeal space was very common in NPC, about 80% (160/200 cases); particularly unilateral or bilateral retro-styloid spaces, about 69.5% (139/200 cases). It was proposed that patients with NPC had a high incidence of ipsilateral cervical node metastasis. Contralateral cervical node metastasis was rare. The development of cervical node metastasis in NPC has to modes: one is direct infiltration of the retro-styloid space by the lesion; the other is along the nasopharyngeal lymphatic rete. The data also showed that patients with NPC who presented symptoms of IX-XII cranial nerve paralyses always had ipsilateral or bilateral retro-styloid space infiltrations.     

Bcl-2 and LMP1 expression in nasopharyngeal carcinomas

In vitro studies of B-cells immortalized by Epstein-Barr Virus (EBV) have shown that B-cell leukemia/lymphoma-2 (bcl-2) protein expression is upregulated by the EBV-latency-associated antigen, latent membrane protein 1 (LMP1). The same phenomenon has also been observed in epithelial cells in vitro. However, such correlation between these 2 markers has not been shown in nasopharyngeal carcinoma (NPC), in which EBV infection is a well-known etiologic factor. This retrospective study examined 35 cases of undifferentiated NPC to answer the question of whether LMP1 and/or bcl-2 presence can be used as biomarkers at treatment response, as well as to see the relationship between bcl-2 and LMP in NPC. Of the 35 patients, 26 (74.3%) were bcl-2, and 10 (28.6%) were LMP1-positive. Although a significant correlation was observed between bcl-2 and LMP1 staining (P =.003), it appeared that bcl-2 expression could be independent of LMP1. Statistical analysis showed that cervical lymph node metastasis (P =.04) and cranial nerve involvement (P =.03) are the only variables that significantly affect patient survival. At this time, bcl-2 and LMP1 presence are not significant indicators of outcome; however, although they are not directly related to survival, expression of both bcl-2 and LMP1 was strongly correlated with cervical lymph node metastasis, which is a potent predictor of patient survival.     

nm23-H1蛋白和P53蛋白在鼻咽癌的表达

为观察ｎｍ２３－Ｈ１基因产物和Ｐ５３基因产物在鼻咽癌（ＮＰＣ０的表达状态，春一ＮＰＣ的发生及转移、预后的产生。采用Ｓ－Ｐ免疫组织化学方法检测ｎｍ２３－Ｈ１基因产物和Ｐ５３基因产物的表达。结果ｎｍ２３－Ｈ１蛋白的表达率为５０．４％，Ｐ５３蛋白表达率为９０．４％。ｎｍ２３－Ｈ１蛋白在颈部有淋巴结转移包块才的表达率为２７．９％，低于无颈部淋结转移包块者的表达率，两者有非常显著性差异。ｎｍ２３－Ｈ１蛋白及     

声门上型喉癌颈淋巴结转移方式及其对预后的影响

目的：探讨影响声门上型喉癌颈淋巴结转移的临床病理因素及颈淋巴结转移对预后的影响。方法：用x^2检验和Logistic回归分析，对55例声门上型喉癌患者的肿瘤临床病理学因素与颈淋巴结转移的关系进行回顾性分析；并对颈淋巴结转移状态，转移颈淋巴结大小、数目、累及区域、最低受累区域等病理学因素对预后的影响进行Cox回归分析。结果：单因素分析显示，肿瘤病理分级、肿瘤大小、肿瘤浸润深度与发生颈淋巴结转移有关；多因素分析显示，肿瘤病理分级、肿瘤大小与发生颈淋巴结转移明显相关；声门上型喉癌患者5年生存率为52．7％。Cox回归分析表明，临床N分期、颈淋巴结转移状态、转移颈淋巴结大小影响患者预后。结论：声门上型喉癌颈淋巴结转移的发生受原发癌病理学因素的影响，它从多个角度明显影响患者预后；对影响预后的淋巴结因素采取相应治疗措施，对提高声门上型喉癌的治疗效果具有重要意义。     

Head and neck metastases from occult abdominal primary site: a case report and literature review

OBJECTIVES: A very rare case of cervical lymph node metastasis from the liver is reported. The clinical findings and the diagnosis of a metastasis to the head and neck from the isolated silent abdominal cancer are discussed. MATERIAL AND METHODS: The clinical and histopathological findings of a 56-year-old woman with a metastatic cervical lymph node of unknown origin are presented, together with a literature review of metastases from an occult abdominal primary. RESULTS: The primary site was identified as an undifferentiated cholangiolocellular carcinoma using immunostaining for anti-cytokeratin subclasses after autopsy. Fifty-two cases of head and neck metastases from an abdominal primary cancer were found and separately summarized according to the metastatic routes. CONCLUSIONS: When a metastatic neck cancer of unknown origin is diagnosed, it is very important to consider the possibility of a metastasis from an abdominal organ. Recognition of metastatic routes and their characteristics is helpful in the search for the occult abdominal primary site. Immunohistochemistry of the metastatic cancer may provide important information for identifying the primary site in cases of metastasis of an undifferentiated carcinoma.     

The role of total parotidectomy in high-grade parotid malignancy: A multisurgeon retrospective review

PurposeDetermine rates of intra-parotid and neck nodal metastasis, identify risk factors for recurrence, and report outcomes in patients with primary high-grade parotid malignancy who undergo total parotidectomy and neck dissection.Materials & methodsRetrospective review of patients undergoing total parotidectomy and neck dissection for high-grade parotid malignancy between 2005 and 2015. The presence and number of parotid lymph nodes, superficial and deep, as well as cervical lymph nodes involved with metastatic disease were assessed. Risk factors associated with metastatic spread to the parotid deep lobe were identified and recurrence rates reported.Results75 patients with median follow-up time of 47 months. 35 patients (46.7%) had parotid lymph node metastasis. Seven patients (9.3%) had deep lobe nodal metastasis without metastasis to the superficial lobe nodes. Nine patients (12%) had positive intra-parotid nodes without positive cervical nodes. Cervical nodal disease was identified in 49.3% patients (37/75). Local, parotid-bed recurrence rate was 5.3% (4/75). Regional lymph node recurrence rate was also 5.3% (4/75). Rate of distant metastasis was 30.6% (23/75). The overall disease free survival rate for all patients at 2 and 5 years were 71% and 60% respectively.ConclusionParotid lymph node metastasis occurred at a similar rate to cervical lymph node metastasis (46.7% and 49.3%, respectively). Deep lobe parotid nodal metastasis occurred in nearly a quarter of patients and can occur without superficial parotid nodal metastasis. Rate of recurrence in the parotid bed, which may represent local or regional recurrence, was similar to regional cervical lymph node recurrence. Total parotidectomy and neck dissection should be considered high-grade parotid malignancy regardless of clinical nodal status.     

The association of lymph node volume with cervical metastatic lesions in head and neck cancer patients

The aim of this study was to determine if volume of cervical lymph node measured via computed tomography (CT) could differentiate metastatic from benign lesions in head and neck cancer patients. We conducted a retrospective review of chart and images in a tertiary referring center in Taiwan. Patients with head and neck cancers underwent radical, modified radical or functional neck dissection were enrolled. The CT images before operation were reassessed by a radiologist and were compared with the results of pathological examination. A total of 102 patients were included for final analyses. Most patients were male (n = 96, 94%) and average age was 50.1 years. Although the average nodal volume in patients with cervical metastases was higher than those of patients without cervical metastases, it was not an independent factor associated with cervical metastasis after controlling for other variables; however, central nodal necrosis on enhanced CT image [odds ratio (OR) 18.95, P = 0.008) and minimal axial diameter >7.5 mm (OR 6.868, P = 0.001) were independent factors correlated with cervical metastasis. Therefore, the volume of cervical lymph node measured from CT images cannot predict cervical metastases in head and neck cancer patients. Measurement of minimal axial diameter of the largest lymph node is a simple and more accurate way to predict cervical metastasis instead.     

鼻咽癌血清新蝶呤水平检测及其意义

目的 :探讨血清新蝶呤与鼻咽癌的关系及临床意义。方法 :采用 EL ISA竞争法检测 5 4例初治鼻咽低分化鳞癌 (鼻咽癌组 )治疗前、后及 32例健康成人 (对照组 )的血清新蝶呤水平。结果 :鼻咽癌组新蝶呤浓度明显高于对照组 (P <0 .0 1)。各 TNM分期之间新蝶呤水平无差异 (P >0 .0 5 )。无淋巴结转移者血清新蝶呤浓度低于有淋巴结转移者 (P <0 .0 5 )。治疗后新蝶呤水平比治疗前明显降低 (P <0 .0 1) ,但仍比对照组高 (P <0 .0 1) ;治疗后 6个月病灶全消者新蝶呤水平仍维持较低水平而病灶部分残留者复又上升 (P <0 .0 1)。结论 :鼻咽癌病理发生过程中可能存在着巨噬细胞介导的细胞免疫过激或免疫应答异常 ;血清新蝶呤水平动态观察可作为鼻咽癌病情评估和疗效监测的一项客观指标。     

基质金属蛋白酶MMP9和MMP2与鼻咽癌转移的相关性研究

探讨基质金属蛋白酶在鼻咽癌表达的意义,方法采用免疫组织化学法对２６例鼻咽癌组织进行标记及分析。结果显示ＭＭＰ９和ＭＭＰ２鼻咽癌的侵润及转移密切相关。ＭＭＰ９和ＭＭＰ２阳性表达率,淋巴结转移组明显高于无淋巴 结转移组;低分化鳞癌高于高分化鳞癌。     

鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响

目的探讨鼻咽癌放疗后颈部淋巴结残留或复发对预后的影响。方法对67例鼻咽癌放疗后颈部淋巴结残留或复发而原发灶未复发的患者的临床病理资料进行回顾分析。选择性别、年龄、原发癌病理类型、残留或复发淋巴结大小、累及的侧数、淋巴结累及区域、累及区域数量、复发淋巴结的手术方式、颈动脉是否受侵、术后是否有严重并发症、是否补充放疗、是否复发、有无远处转移等临床病理因素,用χ2检验和Cox回归进行单因素和多因素分析,并用Kaplan-Meier法对残留和复发患者进行生存分析。结果单因素分析显示有无远处转移与预后明显相关,多因素分析结果表明,残留或复发淋巴结大小、是否累及Ⅴ区、残留或复发淋巴结累及区域数量、手术方式和有无远处转移与预后明显相关。Kaplan-Meier法进行生存分析显示颈部淋巴结残留或复发患者再次治疗的总1、3、5年生存率分别为88.6%、52.2%、38.6%,而采用根治性手术较采用局部手术生存率高。结论远处转移是影响鼻咽癌放疗后颈部淋巴结残留或复发患者预后的决定性因素。而残留或复发淋巴结大小、是否累及Ⅴ区、累及区域数量和手术方式也是重要因素,根治性手术可提高生存率。     

Cervical lymphnode metastasis of early or late T2 tongue carcinoma

Between 1986 and 1997, 72 patients (47 males, 25 females) with previously untreated tongue cancer were treated at our institution (surgery: 67, interstitial radiotherapy: 3, palliative therapy: 2). These patients, especially T2 tongue cancer, were classified into two groups (early T2: < or = 3 cm, late T2: > 3 cm) according to the maximum diameter of the primary lesion, and were analyzed for treatment outcome and cervical lymphnode metastasis. (1) The cumulative 5-year survival rates were 65.9% for all cases, 95.0% for T1 cases, 77.5% (94.1% for early T2, 59.7% for late T2) for T2 cases, 24.3% for T3 cases (4-year survival rate), and 0% for T4 cases. (2) The cumulative 5-year survival rates were 90.8% for pN- patients and 21.7% for pN+ patients and the difference was statistically significant (p < 0.05%). In prognosis, pN- patients were better than pN+ patients. Since the N factor was related to the cause of death in 87.5% (7/8) of T2 tongue cancer, control of regional lymph node involvement was the most important prognostic factor. (3) The overall incidence of cervical lymph node metastasis (pN+ or secondary nodal metastasis) was 35.3% for early T2 and 750% for late T2. The control rate of secondary nodal metastasis was 75.0% for early T2 and 33.3% for late T2. Partial glossectomy only (observation for occult lymphnode metastasis) is recommended for treatment of T2N0, whereas glossectomy with selective neck dissection by the pull-through method is recommended for treatment of late T2.     

High incidence of lymph node metastasis in major salivary gland cancer

OBJECTIVE: To analyze the incidence and risk factors for clinically apparent and occult lymph node metastases in patients with major salivary gland cancers. DESIGN: Cohort of patients with a median follow-up of 46 months (range, 1-174 months). SETTING: University-based referral center. PATIENTS: A total of 160 consecutive patients with complete clinical and pathologic data. INTERVENTION: Neck dissection was performed in all cases. Patients were treated with surgery alone (55%); surgery and radiation therapy (43%); or a combination of surgery, radiation, and chemotherapy (2%). MAIN OUTCOME MEASURE: Incidence of apparent and occult lymph node metastases. Univariate and multivariate analyses were used to evaluate the significance of clinical and pathologic data. RESULTS: Histologically confirmed positive neck was found in 53% of all cases. Histologic diagnosis was significantly related to the incidence of lymph node metastasis: 89% (16/18) for undifferentiated carcinomas. However, so-called low-risk tumors had incidence rates of 22% to 47%. Twenty-one patients (13%) presented with clinically apparent cervical lymph node metastasis. Of the 139 patients with clinical N0 neck, 45% had occult neck metastasis. Neck metastasis was found in 29% (10/34) of T1, 54% (38/70) of T2, 65% (20/31) of T3, and 54% (16/25) of T4 tumors. Assessment of survival according to nodal status revealed significant correlations for overall (P<.001) and disease-free survival (P<.001). CONCLUSIONS: We found a high incidence of lymph node metastasis from major salivary gland cancers. Neck dissections should be considered as an integral part of the surgical approach in patients with major salivary gland cancer, especially if no postoperative radiation therapy is planned.     

鼻咽癌组织内四种肿瘤相关蛋白表达及其与微血管密度和颈淋巴转移的关系

目的 研究人类前列腺癌转移抑制基因（kang ai 1，KAI1）、肿瘤转移抑制基因（nonmetastasis23，nm23）、E26转录因子（E26 transformation-specific-1，ETS-1）、血管内皮生长因子（vascular endothdial growth factor，VEGF）在鼻咽癌组织中的表达，并用CD34标记微血管测定密度，探讨它们之间的相关性及其与鼻咽癌淋巴转移和预后的关系。方法 应用免疫组织化学Envision二步法检测首诊时有颈淋巴转移的鼻咽非角化性癌（non-keratinizing carcinoma，NKC）50例、无淋巴转移的NKC30例和30例鼻咽黏膜慢性炎症组织内KAI1、nm23、ETS-1、VEGF蛋白的表达水平，并分析与NKC组织内微血管密度的关系。结果 KAI1、nm23蛋白在颈淋巴转移组、无颈淋巴转移组和鼻咽黏膜慢性炎症组织中的阳性表达率依次递增（χ^2=6．2，P〈0．05；χ^2=7．4，P〈0．01）；ETS-1、VEGF蛋白在3组间的阳性表达率依次递减（χ^2=12．8，P〈0．01；χ^2=9．1，P〈0．01）。80例NKC病例中KAI1、nm23蛋白阳性表达者的微血管密度（microvascular density，MVD）分别低于其阴性表达者（t=2．4，P〈0．05；t=2．0，P〈0．05）；ETS-1、VEGF蛋白阳性表达者MVD分别高于其阴性表达者（t=2．6，P〈0．05；t=3．6，P〈0．01）。KAI1和nm23蛋白共同阳性表达较两者各自单独阳性表达时MVD降低（t=2．5，P〈0．05，t=2．3，P〈0．05）；淋巴转移率降低（χ^2=5．2，P〈0．01；χ^2=4．3，P〈0．05）；ETS-1和VEGF蛋白共同表达较两者单独表达时MVD增高（t=2．1，P〈0．05；t=2．2，P〈0．05），淋巴转移率增加（χ^2=4．1，P〈0．01；χ^2=4．1，P〈0．01），提示KAI1与nm23蛋白及ETS-1与VEGF蛋白的表达有相互协同的作用。KAI1与nm23蛋白及ETS-1与VEGF蛋白阳性表达成正相关关系（r=0．5，P〈0．05；r=0．4，P〈0．01）。NKC患者有或无颈淋巴转移与治疗后5年生存期的高低差异有统计学意义（χ^2=4．4，P〈0．05）。结论 KAI1、nm23、ETS-1和VEGF蛋白的表达与鼻咽癌组织的微血管密度有明显相关性，与鼻咽癌的淋巴转移和预后密切相关，提示它们可以作为预测鼻咽癌颈淋巴转移及评估预后的参考指标。     

The ultrastructural diagnosis of tumors of the head and neck

Electron microscopy has proved to be a valuable diagnostic tool in surgical pathology. As shown in three illustrative cases, the procedure is most useful in accurately classifying light microscopically diagnosed undifferentiated tumors of the head and neck, and is also helpful in predicting the origin of cervical lymph node metastasis in occult cancer. It also serves to quality control diagnoses made by light microscopy. All surgical specimens are fixed in a fixative that gives adequate ultrastructural preservation and allows retrieval and examination by electron microscopy, if indicated. Recent technical improvements have resulted in a turn-around time of less than two days, thus making diagnostic electron microscopy clinically useful. The ultrastructural examination of undifferentiated tumors has a high diagnostic yield, often obviating additional diagnostic procedures and exploratory surgery. The correct diagnosis results in appropriate therapy and accurate assessment of prognosis.     

Prognostic significance of histopathological parameters in cancer of the larynx

In this study we investigated the prognostic significance of differentiation, the mode of tumor invasion to surrounding tissues, the microscopic appearance of tumor, peritumoral lymphocytic infiltration and cartilage involvement according to disease-free survival, and the recurrence and presence of cervical lymph node metastasis in cancer of the larynx. Only the mode of tumor invasion to surrounding tissues was significantly related to survival (P < 0.05). The patients with “well-defined margin” tumors survive significantly longer than those with “groups of cells, no distinct margin.” Patients with supraglottic tumors and a mode of invasion other than “well-defined margin” have a significantly higher risk of recurrence (P < 0.05) and therefore require adjuvant therapy. Patients with poorly differentiated, cartilage invading, ulcerative supraglottic tumors, and patients with glottic tumors having diffusely infiltrating margins, certainly need elective neck dissection (P < 0.05). According to the multivariant analysis, none of the factors significantly affect disease-free survival independently (P > 0.15). According to multiple logistic regression and cox regression analysis, in decreasing order of significance, the mode of invasion, microscopic tumor appearance and lymphocytic infiltration significantly affect the recurrence and time between surgery and the development of recurrence independently (P < 0.15). Received: 4 December 1997 / Accepted: 12 June 1998