Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Feb 7;12(4):1305.
doi: 10.3390/jcm12041305.

Salvage vs. Primary Total Laryngectomy in Patients with Locally Advanced Laryngeal or Hypopharyngeal Carcinoma: Oncologic Outcomes and Their Predictive Factors

Shahin Tahan Shoushtari  1 , Jocelyn Gal  2 , Emmanuel Chamorey  2 , Renaud Schiappa  2 , Olivier Dassonville  1 , Gilles Poissonnet  1 , Déborah Aloi  3 , Médéric Barret  3 , Inga Safta  4 , Esma Saada  4 , Anne Sudaka  5 , Dorian Culié  1 , Alexandre Bozec  1   6
Affiliations

Salvage vs. Primary Total Laryngectomy in Patients with Locally Advanced Laryngeal or Hypopharyngeal Carcinoma: Oncologic Outcomes and Their Predictive Factors

Shahin Tahan Shoushtari et al. J Clin Med. .

Abstract

Background: The aims of this study were to compare the survival outcomes of salvage vs. primary total laryngectomy (TL) in patients with locally advanced laryngeal or hypopharyngeal carcinoma and to determine their predictive factors.

Methods: Overall (OS), cause-specific (CSS) and recurrence-free survival (RFS) of primary vs. salvage TL were compared in univariate and multivariate analysis taking into account other potential predictive factors (tumor site, tumor stage, comorbidity level etc.).

Results: A total of 234 patients were included in this study. Five-year OS was 53% and 25% for the primary and salvage TL groups, respectively. Multivariate analysis confirmed the independent negative impact of salvage TL on OS (p = 0.0008), CSS (p < 0.0001) and RFS (p < 0.0001). Hypopharyngeal tumor site, ASA score ≥ 3, N-stage ≥ 2a and positive surgical margins were the main other predictors of oncologic outcomes.

Conclusions: Salvage TL is associated with significantly worse survival rates than primary TL highlighting the need for careful selection of patients who are candidates for larynx preservation. The predictive factors of survival outcomes identified here should be considered in the therapeutic decision-making, especially in the setting of salvage TL, given the poor prognosis of these patients.

Keywords: hypopharyngeal carcinoma; laryngeal carcinoma; larynx preservation; salvage surgery; total laryngectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of patient selection. TL: total laryngectomy; SCC: squamous cell carcinoma; RT: radiation therapy; CRT: chemoradiation therapy.
Figure 2
Figure 2
Kaplan–Meier overall (a), cause-specific (b) and recurrence-free (c) survival curves for patients undergoing primary vs. salvage total laryngectomy (TL).
Figure 2
Figure 2
Kaplan–Meier overall (a), cause-specific (b) and recurrence-free (c) survival curves for patients undergoing primary vs. salvage total laryngectomy (TL).
Figure 3
Figure 3
Kaplan–Meier overall (a), cause-specific (b) and recurrence-free (c) survival curves for patients undergoing primary vs. salvage total laryngectomy (TL) according to primary tumor site (larynx vs. hypopharynx).
Figure 3
Figure 3
Kaplan–Meier overall (a), cause-specific (b) and recurrence-free (c) survival curves for patients undergoing primary vs. salvage total laryngectomy (TL) according to primary tumor site (larynx vs. hypopharynx).
Figure 4
Figure 4
ROC curves for overall (OS), cause-specific (CSS) and recurrence-free survivals (RFS). AUC: area under the curve.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Steuer C.E., El-Deiry M., Parks R., Higgins K.A., Saba N.F. An update on larynx cancer. CA Cancer J. Clin. 2017;67:31–50. doi: 10.3322/caac.21386. - DOI - PubMed
    1. Elicin O., Giger R. Comparison of Current Surgical and Non-Surgical Treatment Strategies for Early and Locally Advanced Stage Glottic Laryngeal Cancer and Their Outcome. Cancers. 2020;12:732. doi: 10.3390/cancers12030732. - DOI - PMC - PubMed
    1. Argiris A., Lefebvre J.L. Laryngeal preservation strategies in locally advanced laryngeal and hypopharyngeal cancers. Front. Oncol. 2019;9:419. doi: 10.3389/fonc.2019.00419. - DOI - PMC - PubMed
    1. Department of Veterans Affairs Laryngeal Cancer Study Group. Wolf G.T., Fisher S.G., Hong W.K. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N. Engl. J. Med. 1991;324:1685–1690. doi: 10.1056/NEJM199106133242402. - DOI - PubMed
    1. Lefebvre J.-L., Andry G., Chevalier D., Luboinski B., Collette L., Traissac L., de Raucourt D., Langendijk J. Laryngeal preservation with induction chemotherapy for hypophayngeal squamous cell carcinoma: 10-year results of EORTC trial 24891. Ann. Oncol. 2012;23:2708–2714. doi: 10.1093/annonc/mds065. - DOI - PMC - PubMed

LinkOut - more resources