Optimal management of laryngeal SCC is challenging due to the need to maximize tumor control whilst preserving organ function. We evaluated patients (pts) with laryngeal SCC to identify factors that may affect survival and organ preservation outcomes.
Clinical records of one hundred and eight pts with histologically confirmed laryngeal SCC treated at National Cancer Centre Singapore from 1999-2009 were reviewed. Overall survival (OS), progression-free survival (PFS) and laryngectomy-free survival (LFS) were estimated via Kaplan Meier approach. Associations between clinical characteristics and survival outcomes were evaluated using a step-wise Cox proportional hazards model.
Pts were predominantly male (95%), current or ex-smokers (82%), had good functional status (96% ECOG ≤1); with median age of 66 years (yrs). At diagnosis, the majority (92%) had hoarse voice, 30% had pain. 52% pts had stage I/II, 44% had stage III/IVa/b and 4% had stage IVc SCC. Of 104 pts treated curatively, 64% and 19% of pts received primary radiation (RT) or chemoradiation (CRT), the remainder had upfront surgery alone (3%) or with adjuvant RT/CRT (14%). At a median follow-up of 3.4 yrs, median OS was 4.4yrs, 5-yr OS 46% and 5-yr PFS 33.9%. For pts who underwent primary RT/CRT, 5-yr LFS was 38.1% and 5-yr laryngeal preservation rate 65.5%. On step-wise multivariable analysis, nodal (N)2/3 stage, (N2 and N3 Hazard ratio (HR): 12.46 and 48.35, 95% confidence interval (CI) 6.01-25.80 and 4.82-484.75 respectively); current smoking status (HR 2.48, 95% CI 1.09-5.67), male gender (HR 13.59, 95% CI 2.63-70.33) and presence of pain (HR 1.86, 95% CI 1.09-3.15) were significantly associated with OS. N2 stage and pain were significantly associated with LFS (N2 HR 4.26 (95% CI 2.09-8.59) and pain HR 1.77 (95% CI 1.03-3.06)). N2/3 stage was the only predictive factor for PFS (N2/N3 HR 5.0 and 8.8, 95% CI 2.75-9.39 and 1.10-70.78 respectively).
Clinical nodal stage is the most important factor associated with OS, PFS and LFS in laryngeal SCC. Presence of pain is independently associated with poor OS and LFS and warrants further evaluation as a prognostic factor. Better strategies to improve outcomes in advanced N stage laryngeal SCC are needed.
Clinical trial identification
All authors have declared no conflicts of interest.