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Original Investigation
October 12, 2017

Survival Outcomes for Patients With T3N0M0 Squamous Cell Carcinoma of the Glottic Larynx

Author Affiliations
  • 1Department of Human Oncology, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
  • 2Department of Biostatistics and Medical Informatics, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
  • 3Division of Otolaryngology and Head and Neck Surgery, Department of Surgery, Carbone Comprehensive Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Otolaryngol Head Neck Surg. Published online October 12, 2017. doi:10.1001/jamaoto.2017.1756
Key Points

Question  What are the survival outcomes in patients with clinical T3N0M0 glottic laryngeal carcinoma who undergo definitive surgical vs primary radiotherapy-based approaches?

Findings  In this cohort study of 2622 patients with clinical T3N0M0 glottic laryngeal carcinoma treated with primary surgical or radiotherapy-based approaches, both groups exhibited similar 5-year adjusted survival rates (53% and 54%, respectively).

Meaning  Results of randomized clinical trials substantiated by national outcomes data support the use of radiotherapy-based organ preservation approaches for patients with clinical T3N0M0 glottic larynx cancer without compromising overall survival.

Abstract

Importance  Radiotherapy (RT)–based organ preservation approaches for patients with advanced laryngeal cancer have been established stepwise through prospective randomized clinical trials. However, broad adoption of these approaches has stimulated discussion about long-term results challenging their applicability in a heterogeneous patient population, most recently for patients with T3 disease.

Objective  To define outcomes in patients with clinical T3N0M0 glottic laryngeal cancer treated with definitive surgical and RT-based approaches.

Design, Setting, and Participants  This retrospective cohort study included patients treated from January 1, 2004, through December 31, 2013, with a median follow-up time of 58 months (range, 0-126.6 months) in the National Cancer Database. Of the 4003 patients with T3N0M0 disease, 2622 received definitive therapy defined by the study protocol. Data were obtained from the clinical oncology database sourced from hospital registry data that are collected from more than 1500 Commission on Cancer–accredited facilities. Data were analyzed from September 14, 2016, through April 24, 2017.

Interventions  Radiotherapy, chemoradiotherapy, surgery, surgery and RT, or surgery and chemoradiotherapy

Results  A total of 2622 patients (2251 men [85.9%] and 371 women [14.1%]; median age, 64 years [range, 19-90 years]) were included in the analytic cohort. In the overall patient cohort, the adjusted 5-year survival probability was 53%. No statistical differences were observed between the primary surgery (53%; 95% CI, 48%-57%) and primary RT (54%; 95% CI, 52%-57%) cohorts. In multivariate analysis, patient factors associated with decreased overall survival (OS) included age (hazard ratio [HR], 1.04; 95% CI, 1.03-1.04), insurance status (HR, 1.26; 95% CI, 1.06-1.50), and increasing comorbidity (HR, 1.20; 95% CI, 1.02-1.42).

Conclusions and Relevance  Current management of T3N0M0 glottic laryngeal cancer relies largely on RT-based organ preservation approaches. The present study substantiates randomized clinical trial data supporting the use of RT-based organ preservation approaches for patients with T3N0M0 glottic laryngeal cancer without compromising OS.

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