Considerations and studies of the classification of glottis cancers

: Since 1972, the principles of the T classification of glottic carcinomas have remained unchanged. Nevertheless, discrepancies between T-classification and post-therapeutic pT classification are reported repeatedly and doubts have been expressed about the reliability of this system. Our T classification is based on pathohistological investigations performed 20 years ago. Therefore, the origin of the above-mentioned discrepancies must be sought in the definition and the clinical diagnostics. First, problems of the T classification of glottic cancer are analyzed and discussed on the basis of conditions which must be fulfilled by each classification: (1) clearly defined boundaries of the anatomical regions; (2) clearly defined rules for classification; (3) practicability for the clinician as well for the pathologist and comparability for both, and (4) prognostic relevance. Second, a new definition of the glottic region is proposed. It should be confined to the extension of the vocal ligaments, their anterior commissure and the medial surface of the arytenoid cartilages, including Reinke's space and the epithelial layer covering all the described areas. This is because the glottic region is confined to anatomical areas with reduced lymphatic drainage and a connective tissue barrier. The proposal is based on an anatomical and morphometric investigation of 154 larynx specimens. Third, 403 glottic carcinomas, treated between 1970 and 1984 were classified by the current T classification and histologically by pT classification (UICC 1987). By comparing these two classifications it was established that the early carcinomas had been overestimated and the advanced carcinomas underestimated.(ABSTRACT TRUNCATED AT 250 WORDS)