Larynx-Preserving Surgery Associated with Improved Survival in Early-Stage Glottic Cancer

What treatment and system factors are associated with survival in early-stage glottic cancer, and how do they compare?

Bottom line
There are a number of treatment and system factors that are significantly associated with early-stage glottis cancer survival when controlling for patient and tumor factors.

Background: Approximately 60% of the estimated 13,560 new cases of larynx cancer in 2015 had their origin in the glottis, typically in an early stage. Current guidelines recommend treatment with either definitive radiotherapy or a partial laryngectomy, and some factors, including facility case volume, patient insurance status, and treatment delay, have been shown to influence survival, but their impact in glottic cancer specifically has not been examined.

Study design: Retrospective study of 5,627 adult patients with early glottic cancer (stage I or II) diagnosed between Jan. 1, 2004, and Dec. 31, 2012.

Setting: Commission on Cancer National Cancer Database.

Synopsis: The majority of patients started treatment within 100 days of diagnosis at facilities with an intermediate case volume that were neither academic nor integrated network cancer programs. The most common treatment modality was radiation alone. Of the 941 patients who underwent radiation and larynx-preserving surgery, the majority had surgery and radiation within 90 days of each other. Of the 177 total laryngectomy patients, 52 received surgery after start of radiotherapy. Larynx-preserving surgery alone and larynx-preserving surgery with radiation were associated with improved survival compared to radiation alone. Chemotherapy administration was associated with diminished survival. Intermediate- and low-volume centers; Medicaid, Medicare, and other government insurance, and delay greater than 100 days between diagnosis and treatment were associated with diminished survival. Male sex, comorbidities, year of diagnosis (2004 to 2006 and 2007 to 2009), and, significantly, increasing age (ages 55 and older) were associated with diminished survival. A clinical T stage of 2 was associated with diminished survival, while well-differentiated tumors were associated with improved survival. Limitations include potential selection bias, exclusions due to missing data, and a limit of available data regarding different types of larynx-preserving surgery.

Citation: Cheraghlou S, Kuo P, Judso BL. Treatment delay and facility case volume are associated with survival in early-stage glottic cancer. Laryngoscope. 2016;126:616–622.