Patterns of cervical lymph node metastasis among laryngeal cancer patients presenting at the Kenyatta National Hospital

Abstract

Background Regional metastasis to the cervical lymph nodes is common in laryngeal carcinoma and is one of the most important prognostic factors of the disease irrespective of the mode of treatment. Objective To determine the patterns of cervical lymph node metastasis among laryngeal cancer patients presenting for treatment at the Kenyatta National Hospital. Study design A hospital based descriptive cross-sectional study. Study setting Kenyatta National Hospital ENT and radiology departments. Study population All patients with histologically confirmed laryngeal carcinoma at the hospital not yet on any treatment. Study duration The study was undertaken over a period of 9 months between October 2018 to June 2019. Methodology The study involved 79 patients with cancer of the larynx confirmed on histology who were examined for presence and patterns of cervical lymphadenopathy. Data on their direct laryngoscopy examination findings was also collected. Each patient’s primary and nodal disease stage was confirmed by a contrast-enhanced CT scan of the neck reported by the same Consultant Radiologist. Results Trans-glottic cancer patients were 81.0%, 10.1% supraglottic and 8.9% glottic. 53.2% presented with T4 primary disease, 38.0% T3, 2.5% T2 and 6.3% T1 disease respectively. 45.6% had N0 neck node disease while 54.4% had N+ neck node disease. T4 primary cancer and poorly differentiated histology were significantly associated with N+ neck node status, P=0.001 and 0.010 respectively. Glottic primary cancer was significantly associated with N0 neck node status P=0.003. Analysis Data was analysed using SPSS version 22 and the Chi-squared and Fisher’s exact tests were used to test for association with a P<0.05 being statistically significant. Conclusion The majority of laryngeal cancer patients at the KNH present with trans-glottic cancer at stage T4 primary disease. Both the T4 primary disease and advanced histologic grade of differentiation are significantly associated with presence of cervical lymph node metastasis.