Laryngectomy and Overall Survival in cT4b Laryngeal Squamous Cell Carcinoma.

Abstract

To compare surgical and non-surgical definitive treatment in cT4b laryngeal squamous cell carcinoma (LSCC). The 2004-2019 National Cancer Database (NCDB) was queried for patients with cT4b LSCC (N = 871). Patients undergoing definitive treatment with (1) laryngectomy + radiotherapy (RT)/chemoradiotherapy (CRT), RT alone, or (3) CRT were included in Kaplan-Meier and Cox survival analyses. Of 207 patients undergoing definitive treatment, 41 (19.8%) underwent laryngectomy + RT/CRT therapy and 166 (80.2%) underwent primary RT/CRT. Among patients undergoing laryngectomy + RT/CRT, 15 (39.5%) remained pT4b and 9 (22.1%) had positive margins. There were no documented mortalities within 90 days of laryngectomy. Nodal (79.3% vs. 79.9%, p = 0.038) and distant (30.7% vs. 0.0%, p < 0.001) metastasis were associated with decreased odds of undergoing definitive treatment. Five-year overall survival (OS) of laryngectomy + RT/CRT and definitive RT/CRT was 39% and 22%, respectively (p = 0.005). Laryngectomy + RT/CRT (aHR: 0.54, 95% CI: 0.35-0.84) was associated with higher OS than definitive RT/CRT (p = 0.006). A separate cohort of 2807 patients with cT4a tumors was created; cT4a and cT4b (HR: 1.34, 95% CI: 0.89-2.02, p = 0.165) tumors had similar OS. A minority of patients with cT4b LSCC underwent definitive treatment. Laryngectomy + RT/CRT therapy was safe and associated with higher OS than definitive RT/CRT, despite the high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b LSCC may benefit from laryngectomy.