Total Laryngectomy Versus Larynx Preservation for T4a Larynx Cancer: Patterns of Care and Survival Outcomes
Purpose To examine practice patterns and compare survival outcomes between total laryngectomy (TL) and larynx preservation chemoradiation (LP-CRT) in the setting of T4a larynx cancer, using a large national cancer registry. Methods and Materials Using the National Cancer Database, we identified 969...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2015-07, Vol.92 (3), p.594-601 |
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| creator | Grover, Surbhi, MD, MPH Swisher-McClure, Samuel, MD, MSHP Mitra, Nandita, PhD Li, Jiaqi, BS Cohen, Roger B., MD Ahn, Peter H., MD Lukens, John N., MD Chalian, Ara A., MD Weinstein, Gregory S., MD O'Malley, Bert W., MD Lin, Alexander, MD |
| description | Purpose To examine practice patterns and compare survival outcomes between total laryngectomy (TL) and larynx preservation chemoradiation (LP-CRT) in the setting of T4a larynx cancer, using a large national cancer registry. Methods and Materials Using the National Cancer Database, we identified 969 patients from 2003 to 2006 with T4a squamous cell larynx cancer receiving definitive treatment with either initial TL plus adjuvant therapy or LP-CRT. Univariate and multivariable logistic regression were used to assess predictors of undergoing surgery. Survival outcomes were compared using Kaplan-Meier and propensity score–adjusted and inverse probability of treatment–weighted Cox proportional hazards methods. Sensitivity analyses were performed to account for unmeasured confounders. Results A total of 616 patients (64%) received LP-CRT, and 353 (36%) received TL. On multivariable logistic regression, patients with advanced nodal disease were less likely to receive TL (N2 vs N0, 26.6% vs 43.4%, odds ratio [OR] 0.52, 95% confidence interval [CI] 0.37-0.73; N3 vs N0, 19.1% vs 43.4%, OR 0.23, 95% CI 0.07-0.77), whereas patients treated in high case-volume facilities were more likely to receive TL (46.1% vs 31.5%, OR 1.78, 95% CI 1.27-2.48). Median survival for TL versus LP was 61 versus 39 months ( P |
| doi_str_mv | 10.1016/j.ijrobp.2015.03.004 |
| format | Article |
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Methods and Materials Using the National Cancer Database, we identified 969 patients from 2003 to 2006 with T4a squamous cell larynx cancer receiving definitive treatment with either initial TL plus adjuvant therapy or LP-CRT. Univariate and multivariable logistic regression were used to assess predictors of undergoing surgery. Survival outcomes were compared using Kaplan-Meier and propensity score–adjusted and inverse probability of treatment–weighted Cox proportional hazards methods. Sensitivity analyses were performed to account for unmeasured confounders. Results A total of 616 patients (64%) received LP-CRT, and 353 (36%) received TL. On multivariable logistic regression, patients with advanced nodal disease were less likely to receive TL (N2 vs N0, 26.6% vs 43.4%, odds ratio [OR] 0.52, 95% confidence interval [CI] 0.37-0.73; N3 vs N0, 19.1% vs 43.4%, OR 0.23, 95% CI 0.07-0.77), whereas patients treated in high case-volume facilities were more likely to receive TL (46.1% vs 31.5%, OR 1.78, 95% CI 1.27-2.48). Median survival for TL versus LP was 61 versus 39 months ( P <.001). After controlling for potential confounders, LP-CRT had inferior overall survival compared with TL (hazard ratio 1.31, 95% CI 1.10-1.57), and with the inverse probability of treatment–weighted model (hazard ratio 1.25, 95% CI 1.05-1.49). This survival difference was shown to be robust on additional sensitivity analyses. Conclusions Most patients with T4a larynx cancer receive LP-CRT, despite guidelines suggesting TL as the preferred initial approach. Patients receiving LP-CRT had more advanced nodal disease and worse overall survival. Previous studies of (non-T4a) locally advanced larynx cancer showing no difference in survival between LP-CRT and TL may not apply to T4a disease, and patients should be counseled accordingly.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2015.03.004</identifier><identifier>PMID: 26068492</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age Factors ; Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - therapy ; Chemoradiotherapy - mortality ; COMPARATIVE EVALUATIONS ; Female ; HAZARDS ; Hematology, Oncology and Palliative Medicine ; Humans ; Kaplan-Meier Estimate ; Laryngeal Neoplasms - mortality ; Laryngeal Neoplasms - pathology ; Laryngeal Neoplasms - therapy ; LARYNGECTOMY ; Laryngectomy - methods ; Laryngectomy - mortality ; LARYNX ; Lymph Nodes - pathology ; Male ; Middle Aged ; Neoplasm Staging ; NEOPLASMS ; Organ Sparing Treatments - mortality ; PATIENTS ; PRESERVATION ; Propensity Score ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; Regression Analysis ; Retrospective Studies ; SENSITIVITY ANALYSIS ; Sex Factors ; THERAPY</subject><ispartof>International journal of radiation oncology, biology, physics, 2015-07, Vol.92 (3), p.594-601</ispartof><rights>Elsevier Inc.</rights><rights>2015 Elsevier Inc.</rights><rights>Copyright © 2015 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c511t-5c3d3a16427ab890285c761076e955fef4d555921b0a62c326f3fd170d6508443</citedby><cites>FETCH-LOGICAL-c511t-5c3d3a16427ab890285c761076e955fef4d555921b0a62c326f3fd170d6508443</cites><orcidid>0000-0003-1254-8324</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301615002709$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26068492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22462353$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Grover, Surbhi, MD, MPH</creatorcontrib><creatorcontrib>Swisher-McClure, Samuel, MD, MSHP</creatorcontrib><creatorcontrib>Mitra, Nandita, PhD</creatorcontrib><creatorcontrib>Li, Jiaqi, BS</creatorcontrib><creatorcontrib>Cohen, Roger B., MD</creatorcontrib><creatorcontrib>Ahn, Peter H., MD</creatorcontrib><creatorcontrib>Lukens, John N., MD</creatorcontrib><creatorcontrib>Chalian, Ara A., MD</creatorcontrib><creatorcontrib>Weinstein, Gregory S., MD</creatorcontrib><creatorcontrib>O'Malley, Bert W., MD</creatorcontrib><creatorcontrib>Lin, Alexander, MD</creatorcontrib><title>Total Laryngectomy Versus Larynx Preservation for T4a Larynx Cancer: Patterns of Care and Survival Outcomes</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose To examine practice patterns and compare survival outcomes between total laryngectomy (TL) and larynx preservation chemoradiation (LP-CRT) in the setting of T4a larynx cancer, using a large national cancer registry. Methods and Materials Using the National Cancer Database, we identified 969 patients from 2003 to 2006 with T4a squamous cell larynx cancer receiving definitive treatment with either initial TL plus adjuvant therapy or LP-CRT. Univariate and multivariable logistic regression were used to assess predictors of undergoing surgery. Survival outcomes were compared using Kaplan-Meier and propensity score–adjusted and inverse probability of treatment–weighted Cox proportional hazards methods. Sensitivity analyses were performed to account for unmeasured confounders. Results A total of 616 patients (64%) received LP-CRT, and 353 (36%) received TL. On multivariable logistic regression, patients with advanced nodal disease were less likely to receive TL (N2 vs N0, 26.6% vs 43.4%, odds ratio [OR] 0.52, 95% confidence interval [CI] 0.37-0.73; N3 vs N0, 19.1% vs 43.4%, OR 0.23, 95% CI 0.07-0.77), whereas patients treated in high case-volume facilities were more likely to receive TL (46.1% vs 31.5%, OR 1.78, 95% CI 1.27-2.48). Median survival for TL versus LP was 61 versus 39 months ( P <.001). After controlling for potential confounders, LP-CRT had inferior overall survival compared with TL (hazard ratio 1.31, 95% CI 1.10-1.57), and with the inverse probability of treatment–weighted model (hazard ratio 1.25, 95% CI 1.05-1.49). This survival difference was shown to be robust on additional sensitivity analyses. Conclusions Most patients with T4a larynx cancer receive LP-CRT, despite guidelines suggesting TL as the preferred initial approach. Patients receiving LP-CRT had more advanced nodal disease and worse overall survival. Previous studies of (non-T4a) locally advanced larynx cancer showing no difference in survival between LP-CRT and TL may not apply to T4a disease, and patients should be counseled accordingly.</description><subject>Age Factors</subject><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Chemoradiotherapy - mortality</subject><subject>COMPARATIVE EVALUATIONS</subject><subject>Female</subject><subject>HAZARDS</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Laryngeal Neoplasms - mortality</subject><subject>Laryngeal Neoplasms - pathology</subject><subject>Laryngeal Neoplasms - therapy</subject><subject>LARYNGECTOMY</subject><subject>Laryngectomy - methods</subject><subject>Laryngectomy - mortality</subject><subject>LARYNX</subject><subject>Lymph Nodes - pathology</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>NEOPLASMS</subject><subject>Organ Sparing Treatments - mortality</subject><subject>PATIENTS</subject><subject>PRESERVATION</subject><subject>Propensity Score</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>Regression Analysis</subject><subject>Retrospective Studies</subject><subject>SENSITIVITY ANALYSIS</subject><subject>Sex Factors</subject><subject>THERAPY</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFksuK1EAUhoMoTjv6BiIBN24ST12TuBCk8QYNMzCtuCuqKydamaSqpypp7Le3QmZcuHFVcOo7t_8_WfaSQEmAyLd9afvgD8eSAhElsBKAP8o2pK6aggnx43G2ASahYAm-yJ7F2AMAIRV_ml1QCbLmDd1kt3s_6SHf6XB2P9FMfjzn3zHEOa6x3_l1wIjhpCfrXd75kO-5fvjbamcwvMuv9TRhcDH3XYoFzLVr85s5nOwpFb-aJ-NHjM-zJ50eIr64fy-zb58-7rdfit3V56_bD7vCCEKmQhjWMk0kp5U-1A3QWphKEqgkNkJ02PFWCNFQcgAtqWFUdqxrSQWtFFBzzi6z12tdHyerorETml_GO5f2U5RySZlgiXqzUsfg72aMkxptNDgM2qGfoyKyrgFYxZuE8hU1wccYsFPHYMckgSKgFjNUr1Yz1GKGAqaSGSnt1X2H-TBi-zfpQf0EvF8BTGqcLIZlWEyStjYss7be_q_DvwXMYJ01erjFM8bez8ElpRVRkSpQN8tBLPdABACtoGF_AJemsFc</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Grover, Surbhi, MD, MPH</creator><creator>Swisher-McClure, Samuel, MD, MSHP</creator><creator>Mitra, Nandita, PhD</creator><creator>Li, Jiaqi, BS</creator><creator>Cohen, Roger B., MD</creator><creator>Ahn, Peter H., MD</creator><creator>Lukens, John N., MD</creator><creator>Chalian, Ara A., MD</creator><creator>Weinstein, Gregory S., MD</creator><creator>O'Malley, Bert W., MD</creator><creator>Lin, Alexander, MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope><orcidid>https://orcid.org/0000-0003-1254-8324</orcidid></search><sort><creationdate>20150701</creationdate><title>Total Laryngectomy Versus Larynx Preservation for T4a Larynx Cancer: Patterns of Care and Survival Outcomes</title><author>Grover, Surbhi, MD, MPH ; Swisher-McClure, Samuel, MD, MSHP ; Mitra, Nandita, PhD ; Li, Jiaqi, BS ; Cohen, Roger B., MD ; Ahn, Peter H., MD ; Lukens, John N., MD ; Chalian, Ara A., MD ; Weinstein, Gregory S., MD ; O'Malley, Bert W., MD ; Lin, Alexander, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c511t-5c3d3a16427ab890285c761076e955fef4d555921b0a62c326f3fd170d6508443</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Age Factors</topic><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Chemoradiotherapy - mortality</topic><topic>COMPARATIVE EVALUATIONS</topic><topic>Female</topic><topic>HAZARDS</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Laryngeal Neoplasms - mortality</topic><topic>Laryngeal Neoplasms - pathology</topic><topic>Laryngeal Neoplasms - therapy</topic><topic>LARYNGECTOMY</topic><topic>Laryngectomy - methods</topic><topic>Laryngectomy - mortality</topic><topic>LARYNX</topic><topic>Lymph Nodes - pathology</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>NEOPLASMS</topic><topic>Organ Sparing Treatments - mortality</topic><topic>PATIENTS</topic><topic>PRESERVATION</topic><topic>Propensity Score</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>Regression Analysis</topic><topic>Retrospective Studies</topic><topic>SENSITIVITY ANALYSIS</topic><topic>Sex Factors</topic><topic>THERAPY</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grover, Surbhi, MD, MPH</creatorcontrib><creatorcontrib>Swisher-McClure, Samuel, MD, MSHP</creatorcontrib><creatorcontrib>Mitra, Nandita, PhD</creatorcontrib><creatorcontrib>Li, Jiaqi, BS</creatorcontrib><creatorcontrib>Cohen, Roger B., MD</creatorcontrib><creatorcontrib>Ahn, Peter H., MD</creatorcontrib><creatorcontrib>Lukens, John N., MD</creatorcontrib><creatorcontrib>Chalian, Ara A., MD</creatorcontrib><creatorcontrib>Weinstein, Gregory S., MD</creatorcontrib><creatorcontrib>O'Malley, Bert W., MD</creatorcontrib><creatorcontrib>Lin, Alexander, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grover, Surbhi, MD, MPH</au><au>Swisher-McClure, Samuel, MD, MSHP</au><au>Mitra, Nandita, PhD</au><au>Li, Jiaqi, BS</au><au>Cohen, Roger B., MD</au><au>Ahn, Peter H., MD</au><au>Lukens, John N., MD</au><au>Chalian, Ara A., MD</au><au>Weinstein, Gregory S., MD</au><au>O'Malley, Bert W., MD</au><au>Lin, Alexander, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Total Laryngectomy Versus Larynx Preservation for T4a Larynx Cancer: Patterns of Care and Survival Outcomes</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>92</volume><issue>3</issue><spage>594</spage><epage>601</epage><pages>594-601</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose To examine practice patterns and compare survival outcomes between total laryngectomy (TL) and larynx preservation chemoradiation (LP-CRT) in the setting of T4a larynx cancer, using a large national cancer registry. Methods and Materials Using the National Cancer Database, we identified 969 patients from 2003 to 2006 with T4a squamous cell larynx cancer receiving definitive treatment with either initial TL plus adjuvant therapy or LP-CRT. Univariate and multivariable logistic regression were used to assess predictors of undergoing surgery. Survival outcomes were compared using Kaplan-Meier and propensity score–adjusted and inverse probability of treatment–weighted Cox proportional hazards methods. Sensitivity analyses were performed to account for unmeasured confounders. Results A total of 616 patients (64%) received LP-CRT, and 353 (36%) received TL. On multivariable logistic regression, patients with advanced nodal disease were less likely to receive TL (N2 vs N0, 26.6% vs 43.4%, odds ratio [OR] 0.52, 95% confidence interval [CI] 0.37-0.73; N3 vs N0, 19.1% vs 43.4%, OR 0.23, 95% CI 0.07-0.77), whereas patients treated in high case-volume facilities were more likely to receive TL (46.1% vs 31.5%, OR 1.78, 95% CI 1.27-2.48). Median survival for TL versus LP was 61 versus 39 months ( P <.001). After controlling for potential confounders, LP-CRT had inferior overall survival compared with TL (hazard ratio 1.31, 95% CI 1.10-1.57), and with the inverse probability of treatment–weighted model (hazard ratio 1.25, 95% CI 1.05-1.49). This survival difference was shown to be robust on additional sensitivity analyses. Conclusions Most patients with T4a larynx cancer receive LP-CRT, despite guidelines suggesting TL as the preferred initial approach. Patients receiving LP-CRT had more advanced nodal disease and worse overall survival. Previous studies of (non-T4a) locally advanced larynx cancer showing no difference in survival between LP-CRT and TL may not apply to T4a disease, and patients should be counseled accordingly.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>26068492</pmid><doi>10.1016/j.ijrobp.2015.03.004</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0003-1254-8324</orcidid></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2015-07, Vol.92 (3), p.594-601 |
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| subjects | Age Factors Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - therapy Chemoradiotherapy - mortality COMPARATIVE EVALUATIONS Female HAZARDS Hematology, Oncology and Palliative Medicine Humans Kaplan-Meier Estimate Laryngeal Neoplasms - mortality Laryngeal Neoplasms - pathology Laryngeal Neoplasms - therapy LARYNGECTOMY Laryngectomy - methods Laryngectomy - mortality LARYNX Lymph Nodes - pathology Male Middle Aged Neoplasm Staging NEOPLASMS Organ Sparing Treatments - mortality PATIENTS PRESERVATION Propensity Score Radiology RADIOLOGY AND NUCLEAR MEDICINE Regression Analysis Retrospective Studies SENSITIVITY ANALYSIS Sex Factors THERAPY |
| title | Total Laryngectomy Versus Larynx Preservation for T4a Larynx Cancer: Patterns of Care and Survival Outcomes |
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