Factors Predictive of Survival in Advanced Laryngeal Cancer

Abstract

To determine the factors predictive of improved survival among patients with advanced laryngeal cancer.Design: National hospital-based cancer registry.Patients: Patients treated with total laryngectomy (TL), radiation therapy alone (RT), or combined chemotherapy and radiation therapy (chemo-RT).Results: Of the 10 590 patients meeting the initial inclusion criteria, 7019 had appropriate nonmissing values in all study variables and were included in the analysis. Overall, TL was significantly associated with increased likelihood of survival compared with RT or chemo-RT (PϽ.001). Among patients with stage III cancer, TL and chemo-RT had similar impacts on survival (each showed increased survival compared with RT), whereas TL was associated with significantly greater survival than chemo-RT or RT among patients with stage IV disease (PϽ.001). Overall survival was also decreased among men, black patients (compared with white patients), and patients with Medicare or Medicaid or those who were uninsured (compared with those with private insurance).Conclusions: Among patients with the most advanced disease (stage IV), TL was associated with increased survival compared with chemo-RT or RT, whereas both TL and chemo-RT improved survival over RT among patients with stage III cancer. Insurance type and black race also showed significant associations with survival, which may reflect barriers in access to care (PϽ.001).

Erratum

“…In both the present study and the study by Hoffman et al, 3 outcomes achieved with RT alone were worse than those achieved with other therapy regimens. In contrary to the results previously reported by Dziegielewski et al 5 and Chen and Halpern, 6 our results showed that the LP-CRT cohort was associated with lower mortality risk compared to the TL-PORT cohort (HR 5 0.74; p 5 .03; Figure 5). …”

“…[3][4][5][6][7] For example, Hoffman et al, 3 using a robust NCDB, reported that increased use of nonsurgical approaches for larynx preservation was concurrent with decreased relative survival in patients with T3 laryngeal cancers. However, because Hoffman et al 3 culled data from between 1985 and 2001, before the implementation of IMRT and the publication of RTOG 9001 and the more widespread use of induction and concurrent chemotherapy, their findings, although timely when published, do not accurately reflect the use of RT and combined modality techniques in the current era.…”

“…In a retrospective series from the Alberta Cancer Registry, Dziegielewski et al 5 showed that patients with T3 as well as patients with T4a laryngeal cancer had inferior survival for both the radiation alone and the concurrent CRT cohorts compared to the surgical cohorts. Another NCDB analysis reported by Chen et al, 6 showed increased mortality risk among patients with T3 disease treated with nonsurgical approaches, particularly in patients treated by radiotherapy (RT) alone. More recently, Megwalu and Sikora, 7 analyzing grouped survival data from the Surveillance, Epidemiology, and End Results 18 registry, reported that patients with some T3 laryngeal cancers who were treated with surgery had better survival outcomes than those who were treated with nonsurgical management.…”

“…However, several studies' findings have implied that nonsurgical larynx preservation approaches may be associated with survival decrement. [3][4][5][6][7] Specifically, Hoffman et al, 3 using large-scale series from the National Cancer Data Base (NCDB), reported that the increased use of organ preservation approaches was associated with a decrement in relative survival in patients with T3 laryngeal cancer. Gourin et al, 4 in a retrospective series of locally advanced disease, demonstrated that nonsurgical larynx preservation was associated with poorer survival particularly for patients with T4 disease.…”

“…These findings have led some researchers to question the utility of chemoradiation as first-line therapy for T3 laryngeal cancer. [3][4][5][6][7] This is not an invalid concern, as the VA and RTOG trials took place in an era before the introduction of modern RT techniques. The VA 1 and RTOG 2 studies, designed and conducted several decades ago, enrolled patients who were treated with nonvolumetric imaging-based conventional 2D or 3D CRT (2D/3D CRT).…”