Survival outcomes in advanced laryngeal cancer

Abstract

Importance: Chemoradiation therapy has become increasingly popular in the treatment of advanced laryngeal cancer as part of an organ preservation protocol. However, several studies have reported a decline in survival, possibly attributable to the increased use of radiation and chemoradiation therapy.

Objective: To evaluate survival outcomes of laryngeal conservation vs surgical therapy in the treatment of advanced laryngeal cancer in the United States using a large population-based cancer database.

Design, setting, and participants: Population-based, nonconcurrent cohort study of 5394 patients who received a diagnosis of stage III or IV laryngeal squamous cell carcinoma between 1992 and 2009. Data were extracted from the Surveillance, Epidemiology, and End Results 18 Database.

Interventions: Surgical or nonsurgical therapy.

Main outcomes and measures: Overall survival (OS) and disease-specific survival (DSS).

Results: Patients who received surgical therapy had better 2-year and 5-year DSS (70% vs 64% and 55% vs 51%, respectively; P < .001) and 2-year and 5-year OS (64% vs 57% and 44% vs 39%, respectively; P < .001) than patients who received nonsurgical therapy. The difference in DSS and OS between treatment groups remained after stratification by year-of-diagnosis cohorts (P < .001). The survival gap consistently narrowed with subsequent year-of-diagnosis cohorts. On multivariable analysis, nonsurgical patients had worse DSS (hazard ratio [HR], 1.33 [95% CI, 1.21-1.45]) and OS (HR, 1.32 [95% CI, 1.22-1.43]) after adjustment for year of diagnosis, American Joint Committee on Cancer stage, age, sex, subsite, race, and marital status. Stage III disease (HR, 0.59 [95% CI, 0.54-0.65]), glottic subsite (HR, 0.74 [95% CI, 0.67-0.82]), 2004 to 2009 year-of-diagnosis cohort (HR, 0.79 [95% CI, 0.70-0.90]), female sex (HR, 0.80 [95% CI, 0.72-0.89]), and married status (HR, 0.68 [95% CI, 0.62-0.75]) positively affected DSS. Black race (HR, 1.17 [95% CI, 1.05-1.30]) and increased age (HR, 1.03 [95% CI, 1.02-1.03] for each year) negatively affected DSS.

Conclusions and relevance: Surgical therapy leads to better survival outcomes than nonsurgical therapy for patients with advanced laryngeal cancer. Patients need to be made aware of the modest but significant survival disadvantage associated with nonsurgical therapy as part of the shared decision-making process during treatment selection.