What is the impact of race on laryngeal preservation strategies and overall survival for laryngeal squamous cell carcinoma?
Background: Racial disparities have been identified in head and neck cancer, with higher mortality rates in black patients compared with white patients. National studies suggest that these disparities are due to differences in socioeconomic factors, access to health care, treatment received, presentation of advanced disease, and other comorbidities. Authors sought to determine the impact of race on survival and laryngeal preservation strategies to further define relationships between race and treatment outcome in laryngeal cancer in the U.S.
Study design: Retrospective, national cancer database analysis.
Setting: SEER database.
Synopsis: Black patients were more likely to be diagnosed at a younger age, were more likely to have nodal metastasis, and were more likely to be diagnosed with advanced stage disease, T3 stage disease, and T4 stage disease compared with white, Hispanic, and Asian patients. Of those with T1 to T2 disease, black patients had higher rates of total laryngectomy (TL) as compared with white, Hispanic, and Asian patients, and were also more likely to undergo TL with adjuvant primary radiotherapy (RT). Of those with T3 tumors, black patients were significantly more likely to undergo TL and TL with adjuvant RT compared with white patients. Black patients had significantly worse five-year overall survival as compared with white, Hispanic, and Asian patients; this was also significant by stage and was true regardless of age, gender, year of diagnosis, nodal status, tumor grade, and whether or not patients had lymph node dissection.
Bottom line: Race is an independent prognostic factor for overall survival. Further studies are warranted to evaluate causes for racial disparities and discrepancies in OS and laryngeal preservation strategies.
Citation: Shin JY, Truong MT. Racial disparities in laryngeal cancer treatment and outcome: a population-based analysis of 24,069 patients. Laryngoscope. 2015;125:1667-1674.
—Reviewed by Amy Hamaker