Selected laryngeal squamous cell carcinomas with laryngeal mobility impairment are suitable for curative larynx-preservation treatment: A multi-institutional study on 406 patients from the ARYFIX collaborative group

Abstract

Introduction: Mobility impairment defines a specific subset of laryngeal squamous cell carcinoma (LSCC), with implications for prognosis and treatment. While total laryngectomy (TL) is often considered for mobility-impairing LSCC (MI-LSCC), the role of organ-preserving strategies such as open partial horizontal laryngectomy (OPHL) and non-surgical treatments (NST) remains debated. This study aims to evaluate the outcomes of different treatment strategies for patients with MI-LSCC.

Materials and methods: A retrospective analysis was conducted on 406 MI-LSCC patients using data from the ARYFIX collaborative study. Patients with subglottic tumors or those receiving unimodal radiotherapy (RT) were excluded. Treatment modalities included TL, TL with adjuvant (chemo)radiotherapy ((C)RT), OPHL, OPHL with adjuvant (C)RT, and definitive NST. Survival outcomes, including overall survival (OS), disease-specific survival (DSS), recurrence-free survival (RFS), and laryngo-esophageal dysfunction-free survival (LEDFS), were assessed. Population clustering and propensity score matching (PSM) were used to balance covariates across treatment groups.

Results: The 5-year rates of OS and DSS were 72.0% and 86.2%, respectively. PSM-adjusted analysis indicated that OPHL was associated with the best outcomes. TL with adjuvant (C)RT provided favorable oncologic control, while NST was associated with higher cancer-unrelated mortality and reduced locoregional control. However, NST yielded the best outcomes in patients with N2-3 MI-LSCC. OPHL followed by (C)RT was associated with inferior DSS and unfavorable LEDFS.

Conclusion: In MI-LSCC, OPHL offers satisfactory oncologic and functional outcomes, provided that patient selection is performed carefully. NST, although associated with poorer locoregional control, optimizes outcomes in MI-LSCC with high nodal burden. Treatment for MI-LSCC should be individualized, considering tumor extension, patient fitness, and institutional expertise.

Keywords: Laryngeal preservation treatment; Laryngeal squamous cell carcinoma; Non-surgical treatment; Surgical strategies; Vocal cord mobility impairment.