Prognosis and Predictive factors

ACs are aggressive tumours, with 5- and 10-year accumulative survival rates of 48% and 30%, respectively. Metastases to cervical lymph nodes have observed in 43% of patients, to skin and subcutaneous tissues in 22%, and to other distant sites in 44% (particularly lungs, liver, and bones {2816}.

Similar to TCs, ACs are usually resistant to radiation and chemotherapy. Surgery is preferred and, depending on the site of the tumour, requires a partial or total laryngectomy. Because of the high incidence of cervical lymph node metastasis, a neck dissection, even when the lymph nodes are clinically negative, is warranted {752}.

Factors adversely affecting prognosis include metastatic disease at presentation, positive tumour margins, angiolym-phatic invasion, and tumours larger than one centimeter {2769,2816}. Determination of DNA ploidy has no prognostic significance {1097}.

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