Incidence and mortality of laryngeal cancer in China, 2011

Objective： Laryngeal cancer is the common cancer of the upper aerodigestive tract. We aimed to use the national cancer registration data in 2011 to estimate the incidence and mortality of laryngeal cancer within China. Methods： Comparable, high-quality data from 177 population-based cancer registries were qualified for analysis. The pooled data were stratified by area, sex and age group. National new cases and deaths of laryngeal cancer were estimated using age-specific rates and national population in 2010. All incidence and death rates were age-standardized to the 2000 Chinese standard population and Segi＇s population, which were expressed per 100,000 populations. Results： All 177 cancer registries covered a total of 175,310,169 population （98,341,507 in urban and 76,968,662 in rural areas）, accounting for 13.01% of the national population. The data quality indicators of proportion of morphological verification （MV%）, percentage of cancer cases identified with death certification only （DCO%） and mortality to incidence ratio （Mr/） were 77.98%, 2.62% and 0.55, respectively. Estimated 20,875 new cases of laryngeal cancer were diagnosed and 11,488 deaths from laryngeal cancer occurred in China in 2011. The crude incidence rate of laryngeal cancer was 1.55/100,000 （2.69/100,000 in males and 0.35/100,000 in females）. Age-standardized incidence rates by Chinese standard population （ASIRC） and by world standard population （ASIRW） were 1.13/100,000 and 1.14/100,000, respectively. Laryngeal cancer is much rarer in females than in males. The incidence rate was higher in urban areas than that in rural areas. The crude mortality rate of laryngeal cancer was 0.85/100,000 （1.42/100,000 in males and 0.25/100,000 in females）. Age-standardized mortality rates by Chinese standard population （ASMRC） and by world standard population （ASMRW） were both 0.61/100,000. The mortality rate in males was much higher than that in females. There was no definite difference in mortality rates of laryngeal cancer between urban and rural areas. Conclusions： Larynx is a specialized area and cancer of larynx significantly affects the quality of life for the patients. Comprehensive measures should be carried out to prevent the ascent of laryngeal cancer.

Incidence and mortality of laryngeal cancer in China, 2015

Objective: Using data from cancer registries to estimate laryngeal cancer incidence and mortality in China, 2015.Methods: Data submitted from 501 cancer registries were checked and evaluated according to the criteria of data quality control and 368 registries’ data were qualified for the final analysis. Data were stratified by area(urban/rural), sex, age group and combined with national population data to estimate laryngeal cancer incidence and mortality in China, 2015. China population census in 2000 and Segi’s population were used for agestandardized.Results: The percentage of cases morphological verified(MV%) of laryngeal cancer was 74.18%. The percentage of death certificate-only cases(DCO%) was 2.10%. And the mortality to incidence(M/I) ratio was 0.55.About 25,300 new cases of laryngeal cancer were diagnosed in 2015 and 13,700 deaths were reported. The crude rate of laryngeal cancer was 1.84 per 100,000(males and females were 3.20 and 0.42 per 100,000, respectively).Age-standardized incidence rates by Chinese standard population(ASIRC) and by world standard population(ASIRW) were 1.18 and 1.19 per 100,000, respectively. The cumulative incidence rate(0-74 years old) was 0.15%.The crude mortality rate was 1.00 per 100,000. Age-standardized mortality rates by Chinese standard population(ASMRC) and by world standard population(ASMRW) were 0.61 and 0.61 per 100,000, respectively, with the cumulative rate(0-74 years old) was 0.07%. Incidence and mortality of laryngeal cancer in males were higher than those in females. And the rates in urban areas were higher than those in rural areas.Conclusions: The incidence and mortality of laryngeal cancer in China were low. And the rates were significantly higher in males than in females. Risk factor control and targeted prevention should be strengthened.

Incidence and mortality of laryngeal cancer in China,2008–2012

Objective：To analyze the incidence and mortality rates of laryngeal cancer in China from 2008 to 2012.Methods：Incident and death cases of laryngeal cancer were retrieved from the National Central Cancer Registry（NCCR）database collecting from 135 cancer registries in China during 2008–2012.The crude incidence and mortality rates of laryngeal cancer were calculated by area（urban/rural）,region（eastern,middle,western）,gender and age group（0,1–4,5–9,…,85＋）.China census in 2000 and Segi’s world population were applied for age standardized rates.Join Point（Version 4.5.0.1）model was used for time trend analysis.Results：The crude incidence rate of laryngeal cancer was 1.86/100,000 ranked the 21st in overall cancers.The age-standardized incidence rates by China population（ASIRC）and by World population（ASIRW）were1.22/100,000 and 1.23/100,000,respectively.The crude mortality of laryngeal cancer in China was 1.01/100,000and it was the 21st cause of cancer-related death in overall cancers.Both the age-standardized mortality rates by Chinese standard population（ASMRC）and by world standard population（ASMRW）were 0.63/100,000.Incidence and mortality rates of laryngeal cancer were higher in males than in females and higher in urban areas than in rural areas.Middle areas had the highest incidence and mortality rates followed by eastern and western areas.Incidence and mortality rates of laryngeal cancer retained low level before age of 40 years old but increased greatly after and peaked in age group of 75.Incidence showed significant down trends in recent 10 years by 1.27%annually[95%confidence interval（95%CI）：–2.2%,–0.3%].Mortality declined in females sharply by 5.18%per year although stable in males and both sexes combined.Conclusions：Appropriate targeted prevention,early detection and treatment programs should be carried out to control the local burden of laryngeal cancer.

Circulating immune parameters-based nomogram for predicting malignancy in laryngeal neoplasm

BACKGROUND Malignancy prediction remains important to preoperative diagnosis and postoperative follow-up in laryngeal neoplasm.AIM To evaluate the circulating immune population and develop a nomogram for prediction of malignancy in patients with laryngeal neoplasm.METHODS A primary cohort of 156 patients was divided into laryngeal benign lesion,premalignant lesion and malignant lesion groups.Peripheral blood from patients was measured by blood routine test and flow cytometry.A nomogram was developed and applied to a validation cohort containing 55 consecutive patients.RESULTS Age,gender and seven circulating immune parameters exhibited significant differences between laryngeal benign lesion and premalignant lesion.The nomogram incorporated predictors,including gender,age,smoke index,proportions of monocytes,CD8+T cells,CD4+T cells,B cells and CD4/CD8+T cell ratio.It showed good discrimination between laryngeal premalignant lesion and malignant lesion,with a C-index of 0.844 for the primary cohort.Application of this nomogram in the validation cohort(C-index,0.804)still had good discrimination and good calibration.Decision curve analysis revealed that the nomogram was clinically useful.CONCLUSION This novel nomogram,incorporating both clinical risk factors and circulating immune parameters,could be appropriately applied in preoperative individualized prediction of malignancy in patients with laryngeal neoplasm.

Expression of Hypoxia Inducible Factor-1α and Its Relationship to Apoptosis and Proliferation in Human Laryngeal Squamous Cell Carcinoma

Summary: To investigate the expression of hypoxia inducible factor-1 alpha (HIF-1α) and its relationship to apoptosis and proliferation in laryngeal squamous cell carcinoma (LSCC), immunohistochemical method was used to detect the expression of HIF-1α and PCNA. Tunnel technique was used to detect in situ cell apoptosis in LSCC. Our results showed that the expression of HIF-1α was related to the clinical stages of cancer and lymph node metastasis (P<0.05). The relationship between HIF-1α and PCNA was statistically significant (P<0.05) and no relationship was found between HIF-1α and apoptosis (P>0.05) It is concluded that HIF-1α plays a role in the carcinogenesis of laryngeal carcinoma and is correlated with proliferation, but bears no relationship with the apoptosis of tumor cells in LSCC.

Relationship between different sources of drinking water,water quality improvement and gastric cancer mortality in Changle County--A retrospectivecohort study in high incidence area

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Regional differences in incidence and mortality trends in cancers of the larynx, thyroid, oral cavity and pharynx in England and Scotland: 1975-2002

Context: There have been significant changes in the epidemiology of head and neck cancers (HNC) in the last three decades worldwide. Documenting these trends helps to facilitate cancer prevention measures and aids resource allocation. Objective: To analyse incidence and mortality trends in Head and Neck Cancers (HNC) in the UK and compare regional differences between England and Scotland. Design: Retrospective quantitative analysis of time trends of HNC cases in the UK recorded in the International Agency for Research into Cancer (IARC) CI5 database and WHO mortality database. Setting: Cancer databases with extraction of UK HNC incidence and mortality time trends. Patients: All patients with cancers of the larynx, thyroid, oral cavity and pharynx in the UK (1975-2002) recorded in the IARC and WHO databases. Main Outcome Measures: HNC incidence and mortality trends in the UK. Results: There has been an increase in incidence of oral and pharyngeal cancer in the UK especially among males with higher rates in Scotland. However mortality has increased in Scotland and reduced in England. Thyroid cancer incidence has increased in the UK especially among females with higher rates in Scotland. Mortality has reduced in both regions. Laryngeal cancer among males has increased in incidence particularly in Scotland with a decline in incidence in England. Mortality has reduced significantly in England among males but increased in Scotland. Conclusions: In the UK, Scotland has higher incidence rates of HNC compared with England. Mortality has reduced in England from all the HNC sub-sites but has increased in Scotland for laryngeal, oral & pharynxgeal cancers. Although socioeconomic deprivation and its relation to higher alcohol and tobacco consumption have been highlighted as drivers, further studies are required.

Studies on the interrelationship of Chinese laryngeal carcinoma and human papillomavirus

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ANALYSIS OF C-HA-RAS GENE AMPLIFICATION AND MUTATION IN LARYNGEAL CARCINOMA

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Clinical significance of tumor-associated macrophage infiltration in supraglottic laryngeal carcinoma

Tumor-associated macrophages(TAMs) can elicit contrasting effects on tumor progression,depending on different tumor microenvironment.This study aimed to explore the correlation between TAM infiltration and clinicopathologic characteristics,metastasis,and prognosis of supraglottic laryngeal carcinoma.TAMs in intratumoral and peritumoral regions of 84 specimens of supraglottic laryngeal carcinoma tissues were detected by immunohistochemical staining with monoclonal CD68 antibody.The density of peritumoral CD68+ TAMs in recurrence cases(9/11) and in dead cases(17/23) were significantly higher than those in non-recurrence cases(33/73) and in survival cases(25/61),with significant differences(P = 0.024 and 0.007,respectively).The Kaplan-Meier survival analysis showed a significant relationship between the infiltration of both intratumoral and peritumoral CD68 + TAMs and the overall survival of patients.The 5year survival rate was significantly lower in the group with a high density of intratumoral CD68+ TAMs than in the group with a low density(39.6% vs.82.5%,P < 0.05).Similarly,the 5-year survival rate was significantly lower in the group with a high density of peritumoral CD68+ TAMs than in the group with a low density(50.6% vs.73.1%,P < 0.05).Cox regression analysis revealed that T classification,distant metastasis,and intratumoral or peritumoral CD68 + TAMs were independent factors for disease-free survival,whereas T classification and intratumoral CD68 + TAMs were independent factors for overall survival.The results indicate that TAM infiltration in supraglottic laryngeal carcinoma can be used to predict metastasis and prognosis and is an independent factor for prognosis.

Human development index is associated with mortality-to-incidence ratios of gastrointestinal cancers

AIM:To identify the role of human development in the incidence and mortality rates of gastrointestinal cancers worldwide.METHODS:The age-standardized incidence and mortality rates for gastrointestinal cancers,including cancers of the esophagus,stomach,pancreas,liver,gallbladder,and colorectum,were obtained from the GLOBOCAN 2008 database and United States Cancer Statistics(USCS)report.The human development index(HDI)data were calculated according to the 2011 Human Development Report.We estimated the mortality-toincidence ratios(MIRs)at the regional and national levels,and explored the association of the MIR with development levels as measured by the HDI using a modified"drug dose to inhibition response"model.Furthermore,countries were divided into four groups according to the HDI distribution,and the MIRs of the four HDI groups were compared by one-way ANOVA followed by the Tukey-Kramer post-hoc test.Statespecific MIRs in the United States were predicted from the estimated HDI using the fitted non-linear model,and were compared with the actual MIRs calculated from data in the USCS report.RESULTS:The worldwide incidence and mortality rates of gastrointestinal cancers were as high as 39.4and 54.9 cases per 100000 individuals,respectively.Linear and non-linear regression analyses revealed an inverse correlation between the MIR of gastrointestinal cancers and the HDI at the regional and national levels(<0;P=0.0028 for regional level and<0.0001 for national level,ANOVA).The MIR differed significantly among the four HDI areas(very high HDI,0.620±0.033;high HDI,0.807±0.018;medium HDI,0.857±0.021;low HDI,0.953±0.011;P<0.001,oneway ANOVA).Prediction of the MIRs for individual United States states using best-fitted non-linear models showed little deviation from the actual MIRs in the United States.Except for 28 data points(9.93%of282),the actual MIRs of all gastrointestinal cancers were mostly located in the prediction intervals via the best-fit non-linear regression models.CONCLUSION:The inverse correlation between HDI and MIR demonstrates that more developed areas have a relatively efficacious healthcare system,resulting in low MIRs,and HDI can be used to estimate the MIR.

Study on inhibiting effect of p27 gene on growth of human laryngeal carcinoma Hep-2 cells

Objective To explore the effect of p27gene on th e growth inhibition of laryngeal car cinoma cell line Hep-2.Methods The p27cDNAwas transfected into human lary ngeal carcinoma cell line Hep-2cells with lipofectamine.The cell cycle s were observed by means of FCM assay.p27expression was detected b y dot-blot hybridization and Western blot.Results Expression of p27in Hep-2was identified by Dot blot and Western blot analyses.the growt h rate of Hep-2transfected with p27g ene was markedly suppressed.Cell cy cle analysis by flow cytometry show that the number of cells in G 0 ～G 1 phase of Hep-2cells was significant ly increased while cells in S and G 2 +M phase was decreased compared with that of the control Hep-2cells.Conclusion Transduction of p27gene into lower e xpression cancer cells can restore i ts suppressive effect on cell growth by arrest of cell cycle at G 1 phase.

Trends and predictions for gastric cancer mortality in Brazil

AIM: To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029.METHODS: An ecological study is presented herein,which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of ageperiod and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R. RESULTS: Progressive reduction of mortality rates was observed in the 1980's, and then higher and lower mortality rates were verified in the 2000's, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast(both sexes) and North(men only) regions within the period 1995-1999, followed by rising rates. CONCLUSION: Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates.

Prognostic Value of Ki67 and VE6F Expression in Laryngeal Squamous Cell Carcinoma

OBJECTIVE To investigate the prognostic value of measuring Ki67 and VEGF expression in laryngeal squamous cell carcinoma (LSCC). METHODS The expression of Ki67 and VEGF in 32 LSCC tissues was studied by immunohistochemical staining. Of these cases, 5 recurred (recurrent group), 3 cases metastasized (metastatic group), 8 cases died (deceased group) and 24 cased survived (survival group) over a 3 year period of follow-up after their operation. RESULTS The expression of Ki67 and VEGF in the deceased group was higher compared to that in the survival group (P<0.01). Overexpression of Ki67 was found in the recurrent group and in the metastatic group (P< 0.05). VEGF expression was higher in the recurrent group than in the non recurrent group (P<0.05). With Cox-regression of multivariate analysis, Ki67 (RR:3.236; P=0.001), the clinical T stage (RR: 1.382; P=0.029) and metastasis in lymph nodes (RR:0.316; P=0.033) were shown to be independent prognostic factors for survival of LSCC patients. CONCLUSION Ki67 and VEGF expression is related to the prognosis of LSCC. Overexpression of the 2 markers indicated poor prognosis of the disease, a finding which might be helpful for the treatment of laryngocar-cinoma.

Effect of DRB on the Biological Characteristics of Human Laryngeal Carcinoma Hep-2 Cell Line

In order to study the effect of 5, 6-Dichloro-l-13-D-ribofuranosyl-benzimidazole （DRB） on the biological characteristics of human laryngeal carcinoma Hep-2 cell line in vitro, Hep-2 cells cultured in vitro were treated with different concentrations of DRB. Changes in cell proliferation, apoptotic rate and invasiveness were detected by MTT assay, flow cytometry （FCM） and matrigel in vitro invasion assay, respectively. It was found that DRB inhibited the proliferation of Hep-2 cells in a dose- and time-dependent manner. After being treated with 0, 10, 20, 40, 80 μmmol/L DRB for 24 h, the apoptotic rate in Hep-2 cells was （0.68±0.19）%, （1.95±0.12）%, （8.51±0.26）%, （11.26±0.17）% and （14.99±0.32）%, respectively. The matrigel in vitro invasion assay revealed that DRB began to inhibit the invasion of Hep-2 cells at the concentration of 5 μmmol/L, and with the increase of DRB concentration, the inhibitory effect was enhanced. It was suggested that DRB could influence the essential biological characteristics of Hep-2 cells, inhibit Hep-2 cells proliferation, reduce invasive ability and induce apoptosis of Hep-2 cells.

Neutropenic Fever in Lung Cancer:Clinical Aspects Related to Mortality and Antibiotic Failure

Background and objectives:Lung cancer(LC)is the leading cause of cancer death.Patients treated with chemotherapy are at risk of developing chemotherapy-induced febrile neutropenia(FN),a potentially life-threatening complication.The aims of this study were(1)to characterize FN admissions of patients with LC in a pulmonology department,and(2)to determine associations between patient profiles,first-line antibiotic failure(FLAF)and mortality.Methods:Retrospective observational case-series,based on the analysis of medical records of LC patients that required hospitalization due to chemotherapy-induced FN.Results:A total of 42 cases of FN were revised,corresponding to 36 patients,of which 86.1%were male,with a mean age of 66.71±9.83 years.Most patients had a performance status(PS)equal or less than 1,and metastatic disease was present in 40.5%(n=17).Respiratory tract infections accounted for 42.9%(n=18)of FN cases,and multidrug-resistant Staphylococcus aureus was the most isolated agent.The mortality rate was 16.7%(n=7),and the FLAF was 26.2%(n=11).Mortality was associated with a PS≥2(P=0.011),infection by a Gram-negative agent(P=0.001)and severe anemia(P=0.048).FLAF was associated with longer hospitalizations(P=0.020),PS≥2(P=0.049),respiratory infections(P=0.024),and infection by a Gram-negative(P=0.003)or multidrug-resistant agent(P=0.014).Conclusions:Lower PS,severe anemia,and infections by Gram-negative or multi-resistant agents seem to be associated with worse outcomes in FN patients.

Epidemiology of Cancer in Systemic Sclerosis—Systematic Review and Meta-Analysis of Cancer Incidence, Predictors and Mortality

Objectives: The study was conducted to improve our understanding of the epidemiology of cancer in systemic sclerosis (SSc) by evaluating the incidence, prevalence, relative risk of overall and site-specific malignancies, predictors and cancer-attributable mortality. Methods: MEDLINE, CINAHL, EMBASE and Cochrane Library (inception-May 2012) were searched. Estimates were combined using a random effects model. Consistency was evaluated using the I2 statistic. Results: 4876 citations were searched to identify 60 articles. The average incidence of malignancy in SSc was 14 cases/1000 person-years;the prevalence ranged between 4%-22%. Cancer was the leading cause of non-SSc related deaths with a mean of 38%. Overall SIR for all-site malignancy risk was 1.85 (95%CI 1.52, 2.25;I276%). There was a greater risk of lung (SIR 4.69, 95%CI 2.84, 7.75;I293%) and haematological (SIR 2.58, CI 95% 1.75, 3.81;I20%) malignancies, including non-Hodgkin’s lymphoma (SIR 2.55, 95%CI 1.40, 4.67;I20%). SSc patients were at a higher risk of leukemia (SIR 2.79, 95%CI 1.22, 6.37;I20%), malignant melanoma (SIR 2.92, 95%CI 1.76, 4.83;I235%), liver (SIR 4.75, 95%CI 3.09, 7.31;I20%), cervical (SIR 2.28, 95%CI 1.26, 4.09;I254%) and oropharyngeal (SIR 5.0, 95%CI 2.18, 11.47;I258%) cancers. Risk factors include a-RNAP I/III seropositivity, male sex, and late onset SSc. Smoking and longstanding interstitial lung disease increase the risk of lung cancer;Barrett’s esophagus and a positive family history of breast cancer, respectively, increase the risk of esophageal adenocarcinoma and breast cancer. Conclusions: SSc patients have a two-fold increase in all-site malignancy, and greater risk of lung and haematological malignancies that contribute significantly to mortality. Vigilance should be considered in SSc patients with risk factors for cancer.

Perioperative mortality of metastatic spinal disease with unknown primary: A case report and review of literature

BACKGROUND Spinal metastases are common in patients with malignancies,but studies on those metastasized from unknown primaries are scarce due to the difficulty in treatment and the relatively poor prognosis.Knowledge of surgical complications,particularly perioperative mortality,in patients with spinal metastases from unidentified sources is still insufficient.CASE SUMMARY A 54-year-old man with chest-back pain was diagnosed with spinal metastasis in the seventh thoracic vertebra(T7).Radiographic examinations,as well as needle biopsy and immunohistochemical tests were performed to verify the characteristics of the lesion,resulting in an inconclusive diagnosis of poorly differentiated cancer from an unknown primary lesion.Therefore,spinal surgery was performed using the posterior approach to relieve symptoms and verify the diagnosis.Postoperative histologic examination indicated that this poorly differentiated metastatic cancer was possibly sarcomatoid carcinoma.As the patient experienced unexpectedly fast progression of the disease and died 16 d after surgery,the origin of this metastasis was undetermined.We discuss this case with respect to reported perioperative mortality in similar cases.CONCLUSION A comprehensive assessment prior to surgical decision-making is essential to reduce perioperative mortality risk in patients with spinal metastases from an unknown origin.

External validation of nomograms for predicting cancer-specific mortality in penile cancer patients treated with definitive surgery

Using a population-based cancer registry,Thuret et al.developed 3 nomograms for estimating cancerspecific mortality in men with penile squamous cell carcinoma.In the initial cohort,only 23.0% of the patients were treated with inguinal lymphadenectomy and had pN stage.To generalize the prediction models in clinical practice,we evaluated the performance of the 3 nomograms in a series of penile cancer patients who were treated with definitive surgery.Clinicopathologic information was obtained from 160 M0 penile cancer patients who underwent primary tumor excision and regional lymphadenectomy between 1990 and 2008.The predicted probabilities of cancer-specific mortality were calculated from 3 nomograms that were based on different disease stage definitions and tumor grade.Discrimination,calibration,and clinical usefulness were assessed to compare model performance.The discrimination ability was similar in nomograms using the TNM classification or American Joint Committee on Cancer staging(Harrell's concordance index = 0.817 and 0.832,respectively),whereas it was inferior for the Surveillance,Epidemiology and End Results staging(Harrell's concordance index = 0.728).Better agreement with the observed cancer-specific mortality was shown for the model consisting of TNM classification and tumor grade,which also achieved favorable clinical net benefit,with a threshold probability in the range of 0 to 42%.The nomogram consisting of TNM classification and tumor grading was shown to have better performance for predicting cancer-specific mortality in penile cancer patients who underwent definitive surgery.Our data support the integration of this model in decision-making and trial design.

EXTRACAPSULAR SPREAD IN IPSILATERAL NECK METASTASIS:AN IMPORTANT PROGNOSTIC FACTOR IN LARYNGEAL CANCER

Objective To evaluate the impact of extracapsular spread (ECS) in ipsilateral neck metastasis on prognosis and its related factors in laryngeal cancer. Methods The study included 184 patients who underwent laryngectomy and simultaneous radical or modified radical neck dissection between January 1994 and December 1997 for laryngeal cancer. All of them had a complete 5-year follow-up. We used transparent lymph node detection and continuous slicing method on all neck dissection specimens. Kaplan-Meier model was used for survival analysis and the log-rank test was used to assess significance. Results We found pathological neck metastases in 80 patients. Among them, 26 cases (32.5%) had ECS in ipsilateral neck. ECS incidence increased with advanced pathological N (pN) stages (pN1 3.7%, pN2a 25.0%, pN2b 50.0%, and pN2c 55.6%; P=0.001). ECS incidence also increased with number of positive nodes (1 positive node 8.6%, 2 positive nodes 33.3%, 3 and more positive nodes 66.7%; P<0.001). Incidences of contralateral neck metastases and ipsilateral neck recurrence in patients with ECS were higher than those in patients without ECS (46.2% vs. 24.1%, P=0.046; 34.6% vs. 7.4%, P=0.002). The 5-year survival rate of patients with ECS was significantly lower than that of patients without ECS (23.1% vs. 57.4%, P=0.013). Conclusion ECS is an important prognostic factor in laryngeal cancer. Patients with ECS have a higher incidence of contralateral neck metastasis, so bilateral neck dissection should be selected.