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Primary surgical therapy rose for patients with early-stage laryngeal cancer

Chen AY. Arch Otolaryngol Head Neck Surg. 2011;137:1017-1024.

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From 1985 to 2007, the percentage of patients undergoing primary surgery for early-stage laryngeal cancer increased as the percentage undergoing radiotherapy decreased, whereas the use of chemoradiation rose as the use of total laryngectomy declined.

Wealthier patients with private insurance were more likely to undergo primary surgery or chemoradiation.

Researchers reviewed data collected in the National Cancer Database of 131,694 patients diagnosed with a first primary invasive squamous cell carcinoma of the larynx during the study period. More than half of the patients in the analysis (52.5%) had stage I or stage II disease.

For patients with early-stage disease, multivariate logistic regression analysis showed that blacks (OR=0.81; 95% CI, 0.74-0.89), the uninsured (OR=0.78; 95% CI, 0.68-0.90), Medicaid recipients (OR=0.79; 95% CI, 0.70-0.90) and those living in ZIP codes where less than 14% of the population had earned a high school diploma (OR=1.31; 95% CI, 1.22-1.41) were more likely to receive primary surgery.

For patients with advanced disease, Medicaid recipients (OR=0.88; 95% CI, 0.81-0.97) and patients treated at teaching-research facilities (OR, 0.70; 95% CI, 0.62-0.76) were less likely to undergo chemoradiation therapy. In contrast, blacks (OR=1.14; 95% CI, 1.04-1.24) and patients living in neighborhoods with higher proportions of high school graduates were more likely to receive chemoradiation therapy compared with laryngectomy.

The 4-year survival rate for patients with early-stage disease who underwent local surgery was 79%, and for those who had radiation, it was 71%. Among patients with advanced disease, the 4-year survival rate for laryngectomy was 51%, 48% for chemoradiation and 38% for radiation alone.

Blacks were more likely than whites to die of both early-stage (HR=1.16; 95% CI, 1.03-1.30) and advanced disease (HR=1.15; 95% CI, 1.05-1.25).

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