Stage Migration and Survival Trends in Laryngeal Cancer

Abstract

Background: During the last two decades, significant advancements in the treatment of laryngeal cancer have occurred. Although survival of head and neck cancer patients has improved over time, the temporal trend of laryngeal cancer survival is an area of controversy.

Methods: From 2004 to 2016, 77,527 patients who had laryngeal cancer treated with curative intent in the United States were identified in the National Cancer Database. Relative and observed survival rates were assessed for temporal trends. Multinomial logistic regression investigated the relationship between American Joint Committee on Cancer (AJCC) stage and increasing calendar year.

Results: No significant improvement in 2- or 5-year observed survival (OS) or relative survival (RS) was observed. The 5-year RS ranged from 61.72 to 63.97%, and the 5-year OS ranged from 54.26 to 56.52%. With each increasing year, the proportion of stage 4 disease increased, with risk for stage 4 disease at the time of diagnosis increasing 2.2% annually (adjusted odds ratio [aOR], 1.022; 95% confidence interval [CI], 1.017-1.028; p < 0.001). This increase was driven by a 4.7% yearly increase in N2 disease (aOR, 1.047; 95% CI, 1.041-1.053; p < 0.001), with an annual 1.2% increase in T3 disease (aOR, 1.012; 95% CI, 1.007-1.018; p < 0.001) and a 1.2% increase in T4 disease (aOR, 1.012; 95% CI, 1.005-1.018; p < 0.001).

Conclusion: Despite advances in the field, laryngeal cancer survival in the United States is not improving over time. This may be due to an increase in the proportion of stage 4 disease, driven primarily by increasing nodal disease. To achieve survival improvement commensurate with scientific and technologic advances, efforts should be made to diagnose and treat laryngeal cancer at earlier stages to prevent further stage migration.

Figure 1.

Survival Trends in Laryngeal Cancer in the United States a: Two-year relative and observed survival from 2004-2015 shows no significant improvement in survival during the study period. b: Five-year relative and observed survival from 2004-2011 shows similar lack of survival improvement. b: Five-year relative survival was stable across all stages during the study period. Observed survival was defined as the probability of surviving for a specified time interval based from the study population. Relative survival was defined as the ratio of the proportion of observed survivors in the cohort against age, sex, and gender matched cohort from the United States population.

Figure 2.

AJCC Overall Stage Distribution in Laryngeal Cancer in the United States from 2004-2016 Stage IV disease increased across the study period with reciprocal decreases in Stage I, II and III disease. Stage IV disease increased from 24.4% of all diagnoses in 2004 to 31.1% in 2016.

Figure 3.

T and N Stage Distribution and Subsite Distribution from 2004–2016 a: Trends in T stage distribution. A subtle increase in T3 and T4 disease were observed. b: Trends in N stage distribution–a significant increase in N2 disease with a decrease in N0 disease. c: Trends in subsite distribution–no trends were noted.