Most Patients with Early Stage Glottic Carcinoma in National Cancer Database Receive Radiation as First-Line Treatment

by Linda Kossoff •

What do variables in the National Cancer Database (NCDB) suggest about treatment decisions between surgery and radiation for early stage glottic carcinoma (EGC)?

BOTTOM LINE

Most patients in the NCDB receive first-line treatment with radiation for EGC, a decision associated with various tumor, patient, and treatment facility characteristics.

BACKGROUND: There has been limited investigation of factors contributing to EGC treatment choice using large-scale data such as the NCDB. Given variables specific to the patient, tumor, and facility, an up-to-date U.S. demographic analysis of EGC using the NCDB may potentially contribute to initial treatment selection in patients with EGC.

STUDY DESIGN: Retrospective cohort study.

SETTING: Division of Laryngology, Department of Otolaryngology–Head and Neck Surgery, University of Cincinnati Academic Health Center, Cincinnati, Ohio.

SYNOPSIS: Researchers queried the NCDB for all cases of T1-2N0M0 glottic carcinoma from 2004 to 2016, identifying 34,991 patients with EGC who received surgery alone (6,687 patients), radiation therapy (RT) (20,289 patients), or surgery and RT (8,015 patients). Variables considered included designated tumor characteristics, patient characteristics, and facility characteristics. All reported odds ratios were adjusted for age, gender, race, insurance, residence in a metropolitan area, regions, and facility volume. Findings showed that treatment at an academic center was highly correlated with an increased chance of surgical management of EGC. More diffuse lesions (generally higher T stage) were highly associated with RT. Patients traveling shorter distances for treatment were more than twice as likely to be treated with RT. Surgery was more likely with treatment in the western U.S., higher income, private insurance, metropolitan area residence, female gender, older age, and low facility volume categories. Most patients (98%) receiving dual-modality treatment had surgery followed by radiation, likely a result of intraoperative findings. Study limitations included the lack of accounting for patient comorbidities in EGC treatment type selection.

CITATION: Friedman AD, Gengler I, Altaye M, Tabangin ME. Early-stage glottic carcinoma in the United States: Demographics and treatment choice [published online ahead of print July 19, 2022]. Laryngoscope. doi:10.1002/lary.30305