Akademik Veri Yönetim Sistemi
European Archives of Oto-Rhino-Laryngology, 2025 (SCI-Expanded)
Purpose: Advanced-stage laryngeal squamous cell carcinoma (LSCC) carries a poorprognosis despite advances in surgical and adjuvant therapies. Identifying reliable prognostic markers remains critical to improving risk stratification and tailoring treatment strategies. This study evaluated the prognostic significance of inflammatory and nutritional markers, notably the Prognostic Nutritional Index (PNI) and modified Glasgow Prognostic Score (mGPS), alongside conventional pathological parameters in patients undergoing total laryngectomy. Methods: A retrospective cohort study was conducted on 111 patients with locoregional advanced LSCC treated with primary total laryngectomy between 2013 and 2020. Clinical, histopathological, and laboratory variables were analyzed. Survival outcomes were assessed using Kaplan–Meier analysis and log-rank tests. Multivariate prognostic factors were identified through Cox proportional hazards modeling. Results: PNI < 45 was significantly associated with increased mortality (p = 0.001) and inferior mean survival (62 months vs. 98 months for PNI ≥ 45). In multivariate analysis, PNI < 45 (HR = 0.375; p < 0.001) and lymphovascular invasion (HR = 0.372; p = 0.012) emerged as independent predictors of overall survival. While nodal metastasis correlated with poor survival in univariate analysis, it did not retain significance in the multivariate model. Traditional inflammatory markers (mGPS, NLR, PLR) did not demonstrate prognostic relevance. Furthermore, PNI < 45 was associated with an increased risk of pharyngocutaneous fistula formation (p = 0.007), although neither fistula presence nor postoperative complications correlated with disease recurrence or survival. Conclusions: PNI and lymphovascular invasion are robust independent predictors of survival in patients with advanced LSCC undergoing total laryngectomy. Unlike mGPS, NLR, or PLR, PNI offers a simple, cost-effective prognostic tool that captures nutritional and immunological status. Integrating PNI into clinical practice may enhance individualized risk stratification, and prospective trials are warranted to explore whether preoperative nutritional optimization can improve outcomes in this high-risk population.