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Program Number: B171
Session Name: Poster Session

Differences in Survival Between Surgery versus Radiation-Based Therapy for T3-4a Laryngeal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

Beverly J Fu, BA¹; Alexandra L Potter²; Patrik Pipkorn, Dr³; Kristen Kraimer, Dr¹; Michelle M Chen, Dr¹; Karthik Rajasekaran, Dr⁴; Chi-Fu Jeffrey Yang, Dr²; Jake J Lee, Dr¹; ¹Stanford University; ²Massachusetts General Hospital; ³Washington University; ⁴University of Pennsylvania

Background: Although the incidence of laryngeal cancer has decreased in the U.S., a greater proportion of patients are presenting with advanced disease, resulting in a 25% increase in case-fatality rate from 1986 to 2018. The landmark Veteran Affairs randomized controlled trial established the use of chemoradiation-based therapy as an organ-preserving alternative to total laryngectomy for locally advanced laryngeal cancer. Yet, recent studies have reported a decline in long-term survival associated with non-surgical therapy, suggesting a possible lack of equipoise between surgical and non-surgical treatments for advanced laryngeal squamous cell carcinoma (LSCC).

Objectives: To assess for differences in short- and long-term overall survival (OS) between patients treated with primary surgery versus definitive radiotherapy (RT) using propensity score matching.

Methods: A retrospective cohort study of patients with primary cT3-4a LSCC treated with curative intent between January 2010 and December 2021 was conducted using the National Cancer Database (NCDB). Primary site topographical codes included C320 (Glottis), C321 (Supraglottis), C322 (Subglottis), and histology code 8070 (SCC). Exclusion criteria were receipt of neoadjuvant therapy (chemo-, radio-, or immunotherapy), palliative intent, or presence of distant metastases. Patients were stratified into two cohorts: surgery with and without adjuvant treatment vs. primary RT with and without concurrent chemotherapy.

The primary outcome was OS measured from the time of diagnosis to time of death or last follow-up. Propensity scores were defined as the probability of treatment assignment to surgery vs. primary RT based on age, sex, race, median census-tract education, income, insurance type, treatment facility type, Charlson-Deyo Comorbidity score, cT3 vs. T4a stage, cN stage, year of diagnosis (5-year intervals), tumor size, subsite, and histologic grade. Kaplan-Meier and Cox proportional hazards analyses were performed on propensity score matched cohorts.

Results: In total, 13,674 patients were included, of whom 2,868 (21.0%) underwent primary surgery and 10,806 (79.0%) received primary RT. A propensity score-matched analysis of 963 surgery and 963 primary RT patients was conducted (Tables 1-2). After propensity score matching, median survival for the surgery and primary RT cohorts were 59.5 (95%CI:52.6-68.7) months and 55.7 (95%CI:47.9-63.0) months, respectively (Figure 1). In addition, 2-year OS for the surgery and primary RT cohorts were 70.2% (95%CI:67.2%-73.0%) and 70.0% (95%CI:67.0%-72.8%), respectively; meanwhile 5-year OS for the surgery and primary RT cohorts were 50.0% (95%CI:46.7%-53.2%) and 48.2% (95%CI:44.9%-51.4%), respectively.

There was no significant difference in OS between the surgery and primary RT cohorts (p=0.279) after propensity score matching. The adjusted hazard ratio for surgery relative to primary RT was 0.98 (95%CI:0.85-1.13), suggesting no statistically significant or clinically meaningful difference in survival outcomes between the two treatment modalities.

Similarly, propensity score analysis of the T4a population alone revealed no differences in OS between cohorts; the adjusted hazard ratio for surgery relative to primary RT was 0.93 (95%CI:0.74-1.20).

Conclusion: In this robust propensity score analysis controlling for demographic, socioeconomic, comorbidity, and morphologic risk factors of survival, there was no significant or clinically meaningful difference in survival between surgery and RT-based treatments for locally advanced laryngeal cancer.

Figure 1: Kaplan-Meier analysis of overall survival

 

 

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