Survival Benefit in Advanced Laryngeal Cancer Surgery

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Small but significant advantage in disease-specific, overall survival, even after adjustment.
Small but significant advantage in disease-specific, overall survival, even after adjustment.

For patients with advanced laryngeal cancer, there is a small but significant survival advantage with surgical treatment versus laryngeal conservation, according to a study published online in JAMA Otolaryngology-Head & Neck Surgery.

Uchechukwu C. Megwalu, M.D., M.P.H., and Andrew G. Sikora, M.D., Ph.D., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a population-based study involving 5,394 patients who received a diagnosis of stage III or IV laryngeal squamous cell carcinoma from 1992 to 2009. Survival outcomes were assessed for laryngeal conservation versus surgical therapy.

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The researchers found that two-year and five-year disease-specific (DSS) and overall survival (OS) were better for patients undergoing surgical therapy versus nonsurgical therapy (DSS: 70 versus 64 percent and 55 versus 51 percent, respectively; P < 0.001; OS: 64 versus 57 percent and 44 versus 39 percent, respectively; P < 0.001). 

After stratification by year-of-diagnosis cohorts, the between-group difference in DSS and OS remained significant (P < 0.001). With subsequent year-of-diagnosis cohorts, the survival gap narrowed consistently. After adjustment for multiple confounding variables, nonsurgical patients had worse DSS and OS (hazard ratios, 1.33 and 1.32, respectively).

"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," the authors write.

  1. Uchechukwu, Megwalu C., MD, MPH, et al. "Survival Outcomes in Advanced Laryngeal Cancer." JAMA Otolaryngology-Head & Neck Surgery. doi:10.1001/jamaoto.2014.1671. August 21, 2014.

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