Clinical and Biologic Characteristics and Outcomes in Young and Middle‐Aged Patients With Laryngeal Cancer: A Retrospective Cohort Analysis

Abstract

Objective To describe the clinical and biologic characteristics and outcomes of young and middle-aged (YMA; <65 years) patients according to the presence or absence of traditional risk factors for laryngeal cancer. Study Design Retrospective cohort analysis. Setting Single-institution academic medical center. Methods Patients without a history of clinically significant tobacco use or heavy alcohol use were defined as “nontraditional”: ≤5 pack-years, ≤5 years smoked, ≤14 alcoholic drinks per week, and ≥15-year interval from last tobacco abuse use to diagnosis. Remaining patients were categorized as “traditional.” Select tumor samples were evaluated for bacterial and viral DNA by multiplex polymerase chain reaction. Results Seventy-eight YMA patients with primary laryngeal squamous cell carcinoma were identified, 23% (n = 18) of whom were nontraditional. Nontraditional patients were younger than traditional patients (median age, 51 vs 59 years; P < .001). Twenty-eight tumors were prospectively tested for human papillomavirus (HPV), and nontraditional patients were more likely to exhibit high-risk HPV (57% vs 5%, P < .01). Among 17 select tumors (nontraditional, n = 8; traditional, n = 9), 35% exhibited HPV16 (nontraditional, 63%; traditional, 11%; P = .05). Other viruses were identified but did not differ according to risk status: herpesviruses (40%) and Merkel cell polyomavirus (7%). Chlamydia, β-HPV, and γ-HPV DNA was not detected in any samples. Median length of follow-up was 42 months. On adjusted analyses, nontraditional patients exhibited nonsignificantly improved overall survival (hazard ratio, 0.24 [95% CI, 0.03-1.82]; P = .17) and disease-free survival (hazard ratio, 0.34 [95% CI, 0.10-1.23]; P = .08) as compared with traditional patients. Conclusion Almost one-quarter of YMA patients lacked characteristic risk factors for laryngeal squamous cell carcinoma, and their tumors exhibited a higher prevalence of high-risk HPV. The significance of HPV16 and other tumor viruses with outcomes in nontraditional patients should be evaluated further.

Characteristics and outcomes of young patients with laryngeal cancer: National hospital‐based retrospective cohort analysis

“…A handful of other investigators have also highlighted the unique patient‐ and tumor‐level characteristics of younger patients with laryngeal cancer and wondered if these findings pointed to a nontraditional disease etiology 9,14,17,18 . A recent study of young patients with laryngeal cancer (<40 years old) has similarly shown that young patients are more likely to be female compared to older patients (33.6% vs. 19.6%) 9 .…”

“…A SEER national database study reported that younger cohorts, when compared to their older counterparts, contained a higher proportion of female patients, had more cases of glottic involvement, and were less likely to seen with distant metastatic disease 9 . In addition, a handful of studies have reported heterogeneous survival outcomes 9–14 …”

“…9 In addition, a handful of studies have reported heterogeneous survival outcomes. [9][10][11][12][13][14] Using the hospital-based National Cancer Database (NCDB), we aimed to address these knowledge deficits by evaluating the characteristics, risk factors and outcomes of young patients with laryngeal cancer relative to middle-aged and elderly patients. In light of the emerging evidence supporting alternative, nonchemical carcinogen etiologies of laryngeal cancer in young patients, we hypothesized a priori that young patients with laryngeal cancer would exhibit unique characteristics and outcomes relative to their older counterparts.…”