Better Survival, but Narrowing Gap, With Surgical vs Nonsurgical Treatment of Advanced Laryngeal Cancer
Although chemoradiation has been increasingly used in advanced laryngeal cancer as part of an organ-preservation strategy, there is concern that this practice may have contributed to a decline in survival suggested by some data in this setting. In a population-based cohort study reported in JAMA Otolaryngology Head & Neck Surgery, Megwalu and Sikora found a modest but significant survival advantage with surgical vs nonsurgical treatment in advanced disease.
The study included Surveillance, Epidemiology, and End Results (SEER) data from 5,394 patients diagnosed with stage III or IV laryngeal squamous cell carcinoma between 1992 and 2009.
Better Disease-Specific Survival and Overall Survival
Patients who received surgical therapy had better 2-year (70% vs 64%) and 5-year (55% vs 51%; P < .001) disease-specific survival and 2-year (64% vs 57%) and 5-year (44% vs 39%; P <.001) overall survival. The difference in disease-specific survival and overall survival between treatment groups remained after stratification by year-of-diagnosis cohorts (P < .001).
Narrowing Gap
Although the differences were always statistically significant (P < .001 for all comparisons), the survival gap between surgical and nonsurgical treatment has narrowed in successive year-of-diagnosis cohorts. For example, in the 1992 to 1997 cohort, 2-year disease-specific survival was 68% vs 54%, 5-year disease-specific survival was 51% vs 43%, 2-year overall survival was 63% vs 43%, and 5-year overall survival was 41% vs 29%, whereas in the 2004 to 2009 cohort, 2-year disease-specific survival was 70% vs 67%, 5-year disease-specific survival was 56% vs 53%, 2-year overall survival was 65% vs 60%, and 5-year overall survival was 47% vs 41%.
On multivariate analysis including adjustment for year of diagnosis, American Joint Committee on Cancer stage, age, sex, subsite, race, and marital status, disease-specific survival (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.21–1.45) and overall survival (HR = 1.32, 95% CI =1.22–1.43) remained significantly worse among nonsurgical patients.
Other independent predictors of disease-specific survival included reduced risk for stage III disease, glottic subsite, 2004 to 2009 cohort, female sex, and married status and increased risk for black race and increased age.
The investigators concluded: “Surgical therapy leads to better survival outcomes than nonsurgical therapy for patients with advanced laryngeal cancer. Patients need to be made aware of the modest but significant survival disadvantage associated with nonsurgical therapy as part of the shared decision-making process during treatment selection.”
Uchechukwu C. Megwalu, MD, MPH, of Icahn School of Medicine at Mount Sinai, is the corresponding author for the JAMA Otolaryngology Head & Neck Surgery article.
The authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
