Skip to main content
SpringerLink
Log in

Comparison of treatment modalities for selected advanced laryngeal squamous cell carcinoma

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

The authors aimed to clarify the optimal treatment strategy and the indication of different treatments in managing advanced laryngeal squamous cell carcinoma (LSCC).

Methods

A total of 9700 patients with advanced (T3-4aN0-3M0) LSCC who treated with (1) surgery alone, (2) surgery plus adjuvant radiation with or without chemotherapy (aCRT/RT), or (3) definitive CRT/RT was retrieved from the SEER database. The propensity score matching (PSM) was applied to balance confounding factors. Kaplan–Meier method and Cox proportional hazards regression were used to comparing the overall survival (OS) of patients.

Results

After optimal matching, 907 patients were screened from each treatment cohort. Kaplan–Meier and multivariate analyses presented that patients treated with surgery plus aCRT/CT had significantly longer OS than those treated with either surgery alone or CRT/RT, even after PSM. However, significant interactions were tested in treatment effects in stratified analyses of the primary subsite, T stage, N stage, and insurance status (PInteraction < 0.05 for all). Specifically, surgery plus aCRT/CT significantly improved the OS of patients with supraglottic, T4a, and N + tumors (P < 0.001 for all), while three treatment modalities achieved equal OS rates for patients with glottic, T3, and N0 tumors (P > 0.05 for all). Besides, supraglottic tumors presented a poorer prognosis than glottic subsite.

Conclusion

Current study suggests that surgery with aCRT/RT is the preferred initial therapy for patients with T4a tumors, whereas patients with T3 tumors could be treated with either surgery (followed by aCRT/RT if it presents N +) or definitive CRT/RT for achieving laryngeal preservation. More-intense treatment should be emphasized for advanced supraglottic cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

These data were derived from SEER Program and available in the public domain: https://seer.cancer.gov/.

References

  1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359-386. https://doi.org/10.1002/ijc.29210

    Article  CAS  PubMed  Google Scholar 

  2. Gamez ME, Blakaj A, Zoller W, Bonomi M, Blakaj DM (2020) Emerging concepts and novel strategies in radiation therapy for laryngeal cancer management. Cancers 12:1–21. https://doi.org/10.3390/cancers12061651

    Article  CAS  Google Scholar 

  3. Elicin O, Giger R (2020) Comparison of current surgical and non-surgical treatment strategies for early and locally advanced stage Glottic laryngeal cancer and their outcome. Cancers 12:732. https://doi.org/10.3390/cancers12030732

    Article  PubMed Central  Google Scholar 

  4. Hoffman HT, Porter K, Karnell LH, Cooper JS, Weber RS, Langer CJ, Ang K-K, Gay G, Stewart A, Robinson RA (2006) Laryngeal cancer in the United States: changes in demographics, patterns of care, and survival. Laryngoscope 116:1–13. https://doi.org/10.1097/01.mlg.0000236095.97947.26

    Article  PubMed  Google Scholar 

  5. Grover S, Swisher-McClure S, Mitra N, Li J, Cohen RB, Ahn PH, Lukens JN, Chalian AA, Weinstein GS, O’Malley BW, Lin A (2015) Total laryngectomy versus larynx preservation for T4a larynx cancer: patterns of care and survival outcomes. Int J Radiat Oncol Biol Phys 92:594–601. https://doi.org/10.1016/j.ijrobp.2015.03.004

    Article  PubMed  Google Scholar 

  6. NCCN (2020) NCCN Clinical practice guidelines in oncology (NCCN Guidelines®) Head and Neck Cancers, version 2.2020. https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed 2 Oct 2020

  7. Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, Glisson B, Trotti A, Ridge JA, Chao C, Peters G, Lee D-J, Leaf A, Ensley J, Cooper J (2003) Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091–2098. https://doi.org/10.1056/NEJMoa031317

    Article  CAS  PubMed  Google Scholar 

  8. Stokes WA, Jones BL, Bhatia S, Oweida AJ, Bowles DW, Raben D, Goddard JA, McDermott JD, Karam SD (2017) A comparison of overall survival for patients with T4 larynx cancer treated with surgical versus organ-preservation approaches: a National Cancer Data Base analysis. Cancer 123:600–608. https://doi.org/10.1002/cncr.30382

    Article  PubMed  Google Scholar 

  9. Megwalu UC, Sikora AG (2014) Survival outcomes in advanced laryngeal cancer. JAMA Otolaryngol Head Neck Surg 140:855–860. https://doi.org/10.1001/jamaoto.2014.1671

    Article  PubMed  Google Scholar 

  10. Lin CC, Fedewa SA, Prickett KK, Higgins KA, Chen AY (2016) Comparative effectiveness of surgical and nonsurgical therapy for advanced laryngeal cancer. Cancer 122:2845–2856. https://doi.org/10.1002/cncr.30122

    Article  PubMed  Google Scholar 

  11. Rosenbaum PR (2005) Heterogeneity and causality: unit heterogeneity and design sensitivity in observational studies. Am Stat 59:147–152. https://doi.org/10.1198/000313005X42831

    Article  Google Scholar 

  12. Noone A-M, Lund JL, Mariotto A, Cronin K, McNeel T, Deapen D, Warren JL (2016) Comparison of SEER treatment data with medicare claims. Med Care 54:e55-64. https://doi.org/10.1097/MLR.0000000000000073

    Article  PubMed  PubMed Central  Google Scholar 

  13. Janz TA, Graboyes EM, Nguyen SA, Ellis MA, Neskey DM, Harruff EE, Lentsch EJ (2019) A comparison of the NCDB and SEER database for research involving head and neck cancer. Otolaryngol Head Neck Surg 160:284–294. https://doi.org/10.1177/0194599818792205

    Article  PubMed  Google Scholar 

  14. Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399–424. https://doi.org/10.1080/00273171.2011.568786

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rassen JA, Shelat AA, Franklin JM, Glynn RJ, Solomon DH, Schneeweiss S (2013) Matching by propensity score in cohort studies with three treatment groups. Epidemiology 24:401–409. https://doi.org/10.1097/EDE.0b013e318289dedf

    Article  PubMed  Google Scholar 

  16. Lee J, Little TD (2017) A practical guide to propensity score analysis for applied clinical research. Behav Res Ther 98:76–90. https://doi.org/10.1016/j.brat.2017.01.005

    Article  PubMed  Google Scholar 

  17. Austin PC (2009) Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 28:3083–3107. https://doi.org/10.1002/sim.3697

    Article  PubMed  PubMed Central  Google Scholar 

  18. Camp RL (2004) X-Tile: a new bio-informatics tool for biomarker assessment andoutcome-based cut-point optimization. Clin Cancer Res 10:7252–7259. https://doi.org/10.1158/1078-0432.CCR-04-0713

    Article  CAS  PubMed  Google Scholar 

  19. Paik ES, Lim MC, Kim M-H, Kim YH, Song ES, Seong SJ, Suh DH, Lee J-M, Lee C, Choi CH (2020) Prognostic model for survival and recurrence in patients with early-stage cervical cancer: a Korean Gynecologic Oncology Group Study (KGOG 1028). Cancer Res Treat 52:320–333. https://doi.org/10.4143/crt.2019.124

    Article  PubMed  Google Scholar 

  20. Eskander A, Blakaj DM, Dziegielewski PT (2018) Decision making in advanced larynx cancer: an evidenced based review. Oral Oncol 86:195–199. https://doi.org/10.1016/j.oraloncology.2018.09.019

    Article  PubMed  Google Scholar 

  21. Cosetti M, Yu G-P, Schantz SP (2008) Five-year survival rates and time trends of laryngeal cancer in the US population. Arch Otolaryngol Head Neck Surg 134:370–379. https://doi.org/10.1001/archotol.134.4.370

    Article  PubMed  Google Scholar 

  22. Dyckhoff G, Plinkert PK, Ramroth H (2017) A change in the study evaluation paradigm reveals that larynx preservation compromises survival in T4 laryngeal cancer patients. BMC Cancer 17:609. https://doi.org/10.1186/s12885-017-3608-7

    Article  PubMed  PubMed Central  Google Scholar 

  23. Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, Hong WK, Hillman R, Spaulding M, Laramore GE, Endicott JW, McClatchey K, Henderson WG (1991) Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 324:1685–1690. https://doi.org/10.1056/NEJM199106133242402

    Article  Google Scholar 

  24. Dziegielewski PT, O’Connell DA, Klein M, Fung C, Singh P, Mlynarek MA, Fung D, Harris JR, Seikaly H (2012) Primary total laryngectomy versus organ preservation for T3/T4A laryngeal cancer: a population-based analysis of survival. J Otolaryngol Head Neck Surg 41:S56–S64. https://doi.org/10.2310/7070.2011.110081

    Article  PubMed  Google Scholar 

  25. Patel TD, Echanique KA, Yip C, Hsueh WD, Baredes S, Park RCW, Eloy JA (2019) Supraglottic squamous cell carcinoma: a population-based study of 22,675 cases. Laryngoscope 129:1822–1827. https://doi.org/10.1002/lary.27592

    Article  PubMed  Google Scholar 

  26. Harris BN, Bhuskute AA, Rao S, Farwell DG, Bewley AF (2016) Primary surgery for advanced-stage laryngeal cancer: a stage and subsite-specific survival analysis. Head Neck 38:1380–1386. https://doi.org/10.1002/hed.24443

    Article  PubMed  Google Scholar 

  27. Karatzanis AD, Psychogios G, Waldfahrer F, Kapsreiter M, Zenk J, Velegrakis GA, Iro H (2014) Management of locally advanced laryngeal cancer. J Otolaryngol Head Neck Surg 43:4. https://doi.org/10.1186/1916-0216-43-4

    Article  PubMed  PubMed Central  Google Scholar 

  28. Jones TM, De M, Foran B, Harrington K, Mortimore S (2016) Laryngeal cancer: United Kingdom National Multidisciplinary guidelines. J Laryngol Otol 130:S75–S82. https://doi.org/10.1017/S0022215116000487

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Patel SA, Qureshi MM, Dyer MA, Jalisi S, Grillone G, Truong MT (2019) Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer. Cancer 125:3367–3377. https://doi.org/10.1002/cncr.32292

    Article  PubMed  Google Scholar 

  30. Timmermans AJ, van Dijk BAC, Overbeek LIH, van Velthuysen M-LF, van Tinteren H, Hilgers FJM, van den Brekel MWM (2016) Trends in treatment and survival for advanced laryngeal cancer: a 20-year population-based study in The Netherlands. Head Neck 38:E1247–E1255. https://doi.org/10.1002/hed.24200

    Article  PubMed  Google Scholar 

  31. Bates JE, Amdur RJ, Morris CM, Hitchcock KE, Dziegielewski PT, Boyce BJ, Silver NL, Shaw C, Mendenhall WM (2019) Curative-dose chemoradiotherapy versus total laryngectomy for stage T3–T4 squamous cell carcinoma of the larynx: an “Apples-to-Apples” analysis of the National Cancer Database. Am J Clin Oncol 42:527–533. https://doi.org/10.1097/COC.0000000000000550

    Article  PubMed  Google Scholar 

  32. Timmermans AJ, de Gooijer CJ, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM (2015) T3–T4 laryngeal cancer in The Netherlands Cancer Institute; 10-year results of the consistent application of an organ-preserving/-sacrificing protocol. Head Neck 37:1495–1503. https://doi.org/10.1002/hed.23789

    Article  PubMed  Google Scholar 

  33. Graboyes EM, Zhan KY, Garrett-Mayer E, Lentsch EJ, Sharma AK, Day TA (2017) Effect of postoperative radiotherapy on survival for surgically managed pT3N0 and pT4aN0 laryngeal cancer: analysis of the National Cancer Data Base. Cancer 123:2248–2257. https://doi.org/10.1002/cncr.30586

    Article  PubMed  Google Scholar 

  34. Li R, Yu S, Zhu W, Wang S, Yan L (2019) Studying the impact of young age on prognosis and treatment in laryngeal squamous cell carcinomas using the SEER database. PeerJ 2019:e7368. https://doi.org/10.7717/peerj.7368

    Article  Google Scholar 

Download references

Acknowledgements

The authors would like to sincerely thank the SEER Program for open access to the database.

Funding

This work was supported by the new technology development fund for clinical application of the Qilu Hospital of Shandong University, Jinan, Shandong, China (grant numbers 2018–2 and 2019–16).

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, NHC Key Laboratory of Otorhinolaryngology (Shandong University), Qilu Hospital of Shandong University, Jinan, Shandong, China

    Aihemaiti Wushouer, Wenming Li, Minfa Zhang, Dapeng Lei & Xinliang Pan

Authors
  1. Aihemaiti Wushouer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wenming Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Minfa Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dapeng Lei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xinliang Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AW and WL have contributed equally to this work.

Corresponding author

Correspondence to Xinliang Pan.

Ethics declarations

Conflict of interest

Authors report no conflict of interest regarding the materials or methods used in this study or the findings specified in this paper.

Ethical approval

This study did not require local ethics approval or a statement, as the signed authorization and permission were obtained from the SEER Program to access and use the data cohorts.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wushouer, A., Li, W., Zhang, M. et al. Comparison of treatment modalities for selected advanced laryngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 279, 361–371 (2022). https://doi.org/10.1007/s00405-021-06780-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-021-06780-y

Keywords

Search

Navigation