Long-term survival trend after primary total laryngectomy for patients with locally advanced laryngeal carcinoma

Abstract

Purpose: To evaluate long-term survival trends after primary total laryngectomy (TL) for locally advanced laryngeal carcinoma (LC). Methods: A total of 2094 patients diagnosed with locally advanced LC and underwent primary TL (1992-2011, at least 5-year follow-up) in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Besides the traditional overall survival (OS) and cancer-specific survival (CSS) by using Kaplan-Meier curves, the 3-year conditional survival analysis was also performed to describe the long-term trends in these patients. Time-dependent multivariate competing-risk models were constructed to assess the persistent sub-distribution hazard of prognostic factors. Finally, a nomogram was developed to predict conditional cancer-specific survival. Results: The curves of overall hazard and cancer-specific hazard both quickly reached the apex within the first year since TL, then decreased thereafter. In general, the CS3 steadily increased from within 5 years after TL. In the stratified CS3 analysis, the increments in patients with adverse characteristics were more pronounced. 4 years after TL, the probability of surviving the next year exceeded 90%. The time-dependent multivariate competing-risk models indicated that age and lymph node ratio (LNR) persistently contributed to the cancer-specific outcome. The nomogram based on the competing-risk model was constructed to estimate CSS probability conditional upon 3 years for advanced LC patients having survived 1, 2, and 3 years. Conclusion: Most patients achieved a substantially improved survival rate after surviving a long period after primary TL. Patients diagnosed at older age and with higher LNR should receive more effective follow-up. The predictive nomogram can provide significant evidence for clinical research and practice.

Prognostic role of pretreatment albumin-to-alkaline phosphatase ratio in locally advanced laryngeal and hypopharyngeal cancer: Retrospective cohort study

“…Over the last few decades, radiotherapy Ivyspring International Publisher and chemotherapy have gradually achieved a dominant position [12][13][14][15]. The importance of radical surgery remains, especially for patients with locally advanced stage situations, as surgery has a preferable survival rate [16]. The main surgical strategies prescribed to patients with LHC are total (or partial) laryngectomy and laryngopharyngectomy combined with cervical lymph node dissection [5].…”

Chemoradiotherapy but Not Radiotherapy Alone for Larynx Preservation in T3. Considerations from a German Observational Cohort Study

“…In advanced-stage laryngeal cancer patients, the general negative prognostic value of age and comorbidities has a stronger specific effect on survival with the LP approach. If the addition of chemotherapy to pRT is contraindicated, with pRT alone, patients receive a treatment, which has significantly poorer outcomes in advanced tumor stages according to several studies, e.g., [ 11 , 14 , 33 , 58 , 72 ]. As stated above, the addition of chemotherapy is an important issue for successful LP in T3 laryngeal cancers.…”

“…With comparable age and comorbidities, we observed almost identical outcomes after pRT alone in our study (14%). The British authors recommend informing patients of this difference in expected mortality to help empower their choice for upfront total laryngectomy instead of an attempt at LP with pRT alone [ 72 ]. However, in HNSCC, as Machtay reported, age > 70 years is a significant risk factor for experiencing severe late toxicities after pCRT (1.05 per year ( p = 0.001)) [ 74 ].…”

“…Carboplatin, which is less nephrotoxic but myelodepressive, and the targeted therapeutic agent cetuximab appeared to be of no benefit in patients of advanced age [ 77 ]. Following Lin´s recommendation [ 72 ], elderly, frail, and multimorbid T3 patients who are not suitable for cisplatin-based chemotherapy should instead undergo upfront laryngectomy.…”

Comparison of Histopathological Characteristics of Laryngeal Squamous Cell Carcinoma in Turkish and Syrian Patient Populations

“…[9] A major part of the cases (98%) manifest the morphology of squamous cell carcinoma (SCC). [10][11][12] Many factors such as host characteristics, tumor features and implemented treatment option may affect prognosis in these patients. [13] In the present study, we aimed to identify the histopathological characteristics of the tumors and differences between these characteristics in the materials obtained by laryngectomy performed because of laryngeal squamous cell carcinoma (LSCC) in Turkish and Syrian patient populations.…”