Predictors of Survival in Early-stage Laryngeal Cancer by Treatment Modality

Aim: Our investigation attempts to identify factors associated with improved survival for early-stage laryngeal cancer based on primary therapy using the National Cancer Database (NCDB). Materials and methods: This is a retrospective cohort with data abstracted from the NCDB. Patients with T1 or T2N0M0 laryngeal cancer from 1998 to 2011 who received radiation only, laser surgery, or laser surgery with adjuvant radiation were included. Chi-square analysis was used to assess and investigate the association between treatment and factors. Overall survival (OS) was assessed via Kaplan–Meier method. Log-rank methods were used to determine factors significant for survival, and a multivariable Cox regression model was performed. Results: There were 14,276 patients from the NCDB eligible for this study. The majority (91.2%) of patients received primary radiation, 4.7% laser resection, and 4.0% laser resection with radiation. Five-year survival for laser surgery was 78.8% [95% confidence interval (CI) 75.5–82.1%] vs 67.2% (95% CI 66.4–68.1%) for radiation alone. Multivariate analysis demonstrated advanced age, increased comorbidities, public or uninsured, T2 stage, supraglottic subsite to be independently associated with worse survival. Treatment with laser only and laser with adjuvant radiation demonstrated a hazard ratio of 0.77 (p = 0.055) and 0.65 (p = 0.001) when compared with primary radiation. Conclusion and clinical significance: Survival analysis on early-stage glottic patients in the NCDB showed multiple factors to be independently associated with survival. Outcomes based on treatment suggest an improved survival when utilizing endoscopic surgery as the primary treatment modality.