Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma

• DOI: 10.1002/hed.24918
• Publication Date: 2017-09-30T10:46:52Z
• Authors: Andrew C. Birkeland; Lauren Beesley; Emily Bellile; Andrew J. Rosko; Rebecca Hoesli; Steven B. Chinn; Andrew G. Shuman; Mark E. Prince; Gregory T. Wolf; Carol R. Bradford; J. Chad Brenner; Matthew E. Spector
• Keywords: Male; Time Factors; Databases, Factual; recurrent laryngeal cancer; disease‐specific survival; Clinical sciences; Kaplan-Meier Estimate; Cohort Studies; Otolaryngology; 0302 clinical medicine; Adult Comorbidity Evaluation‐27 (ACE‐27); Cancer; Chemoradiotherapy; Middle Aged; salvage laryngectomy; 3. Good health; Treatment Outcome; Local; Head and Neck Neoplasms; Carcinoma, Squamous Cell; Female; Adult; overall survival; Clinical Sciences; Oncology and Carcinogenesis; Laryngectomy; Risk Assessment; Disease-Free Survival; Databases; 03 medical and health sciences; Rare Diseases; Health Sciences; disease-specific survival; Humans; Neoplasm Invasiveness; Laryngeal Neoplasms; Factual; Retrospective Studies; Aged; Neoplasm Staging; Proportional Hazards Models; Biomedical and Clinical Sciences; Squamous Cell Carcinoma of Head and Neck; Carcinoma; Survival Analysis; Neoplasm Recurrence; Squamous Cell; Otorhinolaryngology; Dentistry; Neoplasm Recurrence, Local; Digestive Diseases; Adult Comorbidity Evaluation-27; Follow-Up Studies

AbstractBackgroundTotal laryngectomy remains the treatment of choice for recurrent/persistent laryngeal squamous cell carcinoma (SCC) after radiotherapy (RT) or chemoradiotherapy (CRT). However, despite attempts at aggressive surgical salvage, survival in this cohort remains suboptimal.MethodsA prospectively maintained single‐institution database was queried for patients undergoing total laryngectomy for recurrent/persistent laryngeal SCC after initial RT/CRT between 1998 and 2015(n = 244). Demographic, clinical, and survival data were abstracted. The Kaplan‐Meier survival curves and hazard ratios (HRs) were calculated.ResultsFive‐year overall survival (OS) was 49%. Five‐year disease‐free survival (DFS) was 58%. Independent predictors of OS included severe comorbidity (Adult Comorbidity Evaluation‐27 [ACE‐27] scale; HR 3.76; 95% confidence interval [CI] 1.56‐9.06), and positive recurrent clinical nodes (HR 2.91; 95% CI 1.74‐4.88).ConclusionSevere comorbidity status is the strongest predictor of OS, suggesting that increased attention to mitigating competing risks to health is critical. These data may inform a risk prediction model to allow for focused shared decision making, preoperative health optimization, and patient selection for adjuvant therapies.