الفهرس 
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Abstract
In Egypt, 1029 new cases were diagnosed in 2018 and 910 cases died in 2018 from head and neck cancers. The most significant risk factor for laryngeal cancer development is tobacco smoking; with synergistic increase in laryngeal cancer incidence when associated with alcohol abuse.
Squamous cell carcinoma (SCC) and its variants represent the most common malignancy in head and neck. Two major pathways are implicated in the development of invasive SCC in the head and neck: tumors related to tobacco and alcohol and those associated with human papilloma virus (HPV).
The accumulation of genetic and epigenetic changes and abnormalities in cancer associated signaling pathways are the main causes for development of various types of cancers including HNSCC.
Immune system plays a main role in protecting our bodies from cancers and rejecting it. However cancer cells affect the immune system and use its components to promote its growth and survival. T- lymphocytes are considered the crucial component of antitumor immunity, with CD8+ T cells serving as cytotoxic effector cells. There must be a balance in controlling cytotoxic T cells (CTLs) activation and inhibition. Some checkpoint proteins on CTLs help them to become fully active. These are the activating checkpoint proteins. CTLs also display on their surface a range of inhibitory checkpoint proteins.
Clinical, radiological and endoscopic work-up should be done for all patients and take a biopsy from any suspicious lesion for proper assessment and staging of primary laryngeal carcinoma as this will impact the treatment protocol.
Early stage of laryngeal cancer can be treated with single modality approach either with radiation therapy (RT) or with laryngeal preservation surgery. A multidisciplinary team with experience in the treatment of head and neck cancer plays an important role in management of patients with advanced (stage III and IV) cancer of the larynx including members who would be involved in either a primary surgical or nonsurgical approach (e.g. RT, CRT).
Tumor infiltration lymphocytes and PDL-1 expression proved to play an important prognostic role in different malignancies. We aimed at evaluating this role in laryngeal cancer. We prospectively analyzed the pre-treatment paraffin blocks for laryngeal cancer patients, whether on the laryngoscopy or operative specimens, to identify the CD8-positive cells in the tumor epithelium or stroma and the PDL-1 expression on the tumor cells.
40 patients were included in our study; 12 patients had early stage disease (I or II) and 28 with advanced stage (III or IV). PDL-1 expression was positive in 92.5%. Neither the PDL-1 nor CD-8 were found significantly correlated to OS in the whole population, however patients with advanced stage, median OS was significantly low for negative or low compared to high PDL-1 expression (11.7 vs 25.2 months (p = 0.036)), a trend of better OS in high CD8 Epithelial expression (25.1 versus 15.9, P = 0.514) and again trend of higher OS in high CD8 Stromal expression (25.3 versus 15.6 months, p = 0.375). Also there were significant correlation between the CD8 expression in the tumor epithelium and stroma with the PDL-1 expression with p-value of 0.001 and < 0.0001 respectively.