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Surgery improved outcomes in advanced laryngeal cancer
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Patients with advanced laryngeal cancer who underwent surgery experienced longer disease-specific survival and OS than those treated with nonsurgical therapy, according to results of a SEER analysis.
Uchechukwu C. Megwalu, MD, MPH, of the department of otolaryngology—head and neck surgery at Icahn School of Medicine at Mount Sinai, and colleagues used the SEER 18 database to identify 5,394 patients diagnosed with stage III or stage IV laryngeal squamous cell carcinoma in between 1992 and 2009. The mean age of the population was 61 years, and 78.4% were male.
Researchers determined 2,560 patients underwent surgery and 2,834 received nonsurgical therapy.
Data showed the use of nonsurgical treatment significantly increased over time, from 32% among those diagnosed between 1992 and 1997 to 62% among those diagnosed between 2004 and 2009 (
A greater proportion of patients who underwent surgery achieved disease-specific survival at 2 years (70% vs. 64%) and 5 years (55% vs. 51%;
The survival benefit associated with surgery persisted regardless of year of diagnosis (
A multivariable analysis adjusted for year of diagnosis, American Joint Committee on Cancer stage, age, sex, disease subsite, race and marital status indicated nonsurgical therapy was associated with worse disease-specific survival (HR=1.33; 95% CI, 1.21-1.45) and OS (HR=1.32; 95% CI, 1.22-1.43).
Patients with stage III disease (HR=0.59; 95% CI, 0.54-0.65) or a glottic subsite (HR=0.74; 95% CI, 0.67-0.82), as well as those who were diagnosed between 2004 to 2009 (HR=0.79; 95% CI, 0.7-0.9), female (HR=0.8; 95% CI, 0.72-0.89) or married (HR=0.68; 95% CI, 0.62-0.75), experienced significantly improved disease-specific survival.
Black race (HR=1.17; 95% CI, 1.05-1.3) and each 1-year increase in age (HR=1.03; 95% CI, 1.02-1.03) were associated with worse disease-specific survival.
“Organ preservation protocols have been shown to be as efficacious as surgical therapy for advanced laryngeal cancer,” Megwalu and colleagues concluded. “However, the findings of the present study suggest that they are not as effective as surgery in real-world clinical settings. Potential reasons for these findings include poor patient selection, inadequate follow-up, incomplete treatment and interrupted treatment sessions. 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.”
Disclosure: The researchers report no relevant financial disclosures.
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