From 1992 to 2009, the SEER database identified a total of 5,301 patients meeting the inclusion criteria. The use of radiation therapy increased over time: 59.0% in the 1992 to 1997 cohort; 80.1% in 1998 to 2003, and 82.5% in 2004 to 2009 (p < .001).

Patients who received surgical therapy had better overall survival (OS) than patients who received radiation therapy (p < .001) (Figure 1). The difference in OS between treatment groups remained after stratification by stage (p < 0.001 for Stage I; p = 0.03 for Stage II), as well as by subsite (p < .001). The difference in OS between treatment groups also remained after stratifying by year of diagnosis cohorts (p = 0.02, p = 0.01, and p < 0.001, respectively for each year of diagnosis cohort).

The results of the multivariable analysis are shown in Table 3. Patients who received radiation therapy had worse OS (hazard ratio [HR] 1.29) after adjusting for year of diagnosis, AJCC stage, age, sex, subsite, race, and marital status. Female sex (HR 0.79), glottic subsite (HR 0.46), T1 stage (HR 0.74), and married status (HR 0.67) had positive impacts on OS. Black race (HR 1.25), increased age (HR 1.1 for each year), and 1992 – 1998 year of diagnosis cohort (HR 1.22) had negative impacts on OS.

Objectives: Analyze cumulative survival rates for early stage laryngeal cancer comparing radiation and surgical therapy. The primary independent variable was the mode of therapy (radiation versus surgical therapy.)

Methods: Data extracted from SEER Database. Study cohort included patients with stage I and II laryngeal squamous cell carcinoma between 1992 and 2009. Radiotherapy cohort included patients who received external beam radiation alone; surgical cohort included patients who received surgical resection alone.

Results: A total of 5,301 patients were extracted from the SEER database. Radiation therapy increased over time, from 59.0% in the 1992-1997 cohort, to 80.1% in the 1998 to 2003 cohort, and 82.5% in the 2004 to 2009 cohort (p < .001). Five year overall survival was improved in the surgical cohort- 78.4% vs. 68.7 % (p< 0.001). Multivariable analysis showed that patients who received radiation therapy had worse OS (hazard ration [HR] 1.29) after adjusting for year of diagnosis, AJCC stage, age, sex, subsite, race, and marital status.

Conclusions: The proportion of patients with early stage laryngeal cancer receiving radiation instead of surgery has significantly increased since the publication of the VA Laryngeal Cancer study. We show that the five year overall survival in patients receiving radiation is significantly worse than surgical therapy after adjusting for stage, subsite, and year of diagnosis.

ABSTRACT

METHODS

RESULTS RESULTS

Survival  Outcomes  in  Early  Stage  Laryngeal  Cancer

Haig  Panossian,  MD  and  Uchechukwu  Megwalu,  MDIcahn  School  of  Medicine  at  Mount  Sinai

Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with stage I and stage II laryngeal squamous cell carcinoma between 1992 and 2009. Exclusion criteria included positive nodal status, distant metastasis, multiple primary tumors, medical contraindication for surgery, and cases in which surgery was recommended but was not performed.

The radiotherapy cohort included patients who received external beam radiation alone while the surgical cohort included patients who received surgical resection alone (either endoscopic or open). Three cohorts were examined on the basis of year of diagnosis (1992 - 1997, 1998 -2003, 2004 - 2009.) Race was recorded in the SEER database as “White”; “Black”; “Other: American Indian, Alaska Native, Asian/Pacific Islander”; or “Unknown.” Marital status was grouped as “married” (including common law) or “single” (single-never married, divorced, widowed).

The SEER computer software (SEER*Stat version 8.1.5) was used to extract data from the SEER database. The statistical analysis was performed using IBM SPSS version 20. Survival analysis was performed using Kaplan-Meier analysis. Cox proportional hazards regression model was used for multivariable survival analysis. P value of less than 0.05 was considered statistically significant. This study was exempt from review by the Icahn School of Medicine at Mount Sinai Institutional Review Board because it was conducted using de-identified public data.

1. The use of radiation therapy for treatment of early stage laryngealcancer has increased since 1992.

2. Early stage laryngeal cancer treated with surgical therapy hasimproved survival over treatment with radiation therapy.

3. Stage I disease, glottic subsite, female gender and married status havepositive impacts on overall survival, while black race and age havenegative impacts.

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Table 1. Patient Characteristics

Overall (n=5301)

Surgery (n=1070)

Radiation (n=4231) P value

Average Age 63.6 63.3 63.9 0.19

Male Gender

4402 (83.1%) 901 (84.2%) 3501

(82.7%) 0.26

Race <0.001

White 4460 (84.1%) 941 (87.9%) 3519

(83.2%)

Black 673 (12.7%) 90 (8.4%) 583 (13.8%)

Married 3357 (63.3%) 705 (65.9%) 2652

(62.7%) 0.05

T1 Stage 4092 (77.2%) 934 (87.3%) 3158

(74.6%) <0.001

Glottic subsite

4147 (78.2%) 880 (82.2%) 3267

(72.2%) <0.001

Overall SurvivalVariable 5-year P valueOverallSurgery 78.40% <0.001

Radiation 68.70%1992-1997

Surgery 79.60% 0.02Radiation 62.80%

1998-2003Surgery 78.70% 0.01

Radiation 71.20%2004-2009

Surgery 77.80% <0.001Radiation 67.90%

T1 StageSurgery 80.10% <0.001

Radiation 71.70%T2 Stage

Surgery 66.50% 0.03Radiation 59.70%

Glottic SubsiteSurgery 55.00% <0.001

Radiation 47.90%Supraglottic Subsite

Surgery 49.50% <0.001Radiation 33.80%

Variable Coefficient (SE) Wald 𝛘2 HR (95% CI) P valueRadiation Treatment

0.256 (0.060) 17.85 1.29 (1.15-1.45) <0.001

Age 0.054 (0.002) 629.73 1.1 (1.05-1.06) <0.001Cohort1992-1998 0.195 (0.079) 6.03 1.22 (1.04-1.42) 0.0141998-2003 0.042 (0.056) 0.58 1.04 (0.94-1.16 0.45T1 Stage -0.302 (0.061) 24.91 0.74 (0.66-0.83) <0.001

Glottic Subsite -0.788 (0.055) 202.29 0.46 (0.41-0.51) <0.001Female Gender -0.233 (0.062) 13.96 0.79 (0.70-0.90) <0.001

RaceBlack 0.219 (0.067) 10.77 1.25 (1.09-1.42) 0.001Other -0.449 (0.153) 8.55 0.64 (0.47-0.86) 0.003

Married -0.407 (0.047) 73.65 0.67 (0.61-0.73) <0.001

Table 3. Factors Predictive of Overall Survival

Table 2. Univariable Analysis

Figure 1. Five-year Overall Survival on the Basis of Therapy

CONCLUSIONS

REFERENCES