Abstract
A retrospective, longitudinal study of 1,616 patients with primary laryngeal squamous cell carcinoma (LSCC) at a single center in Norway during 1983–2010 was undertaken to investigate overall survival, disease specific survival, disease-free survival, prognostic factors for overall survival, and impact of recurrence among all-stage laryngeal cancer patients over 15 years' follow-up. The prognostic impact of gender, age, smoking/alcohol, subsite, tumour, node and metastasis staging, period and modality of treatment were evaluated using Kaplan-Meier and Cox proportional hazard analyses. The importance of recurrence on survival was assessed based on case fatality rates. Five-year overall survival was 56.8%, 64.0% and 38.8%, and disease-specific survival was 80.2%, 87% and 61.6%, respectively, for the entire cohort and for glottic and supraglottic LSCC. Old age, advanced-stage LSCC and supraglottic cancer were associated with lower overall survival. The risk of disease-specific death plateaued after five years and varied significantly by subsite. Multivariate analysis of glottic LSCC revealed that surgical treatment improved overall survival, whereas old age, alcohol, T3-T4 status, positive N-status and no treatment were associated with worse survival. In supraglottic LSCC, age, alcohol, and positive N-status had a significant impact on overall survival by multivariate analysis. Five-year overall survival and disease-specific survival among patients with recurrent disease were 34% and 52%, respectively. In conclusion, marked difference in overall survival between glottic and supraglottic LSCC underline the importance of subsite-specific survival analysis. T-status and primary surgical management is essential only for glottic LSCC, emphasizing the importance of correct disease classification. Inferior outcomes in supraglottic LSCC are associated with old age, positive N-status, and improved follow-up routines are necessary. Primary tumor control is essential since recurrence impairs survival considerably in all subsites. The potential benefit of a primary surgical approach towards T3 LSCC awaits further investigation.
Highlights
Despite progress in the management of laryngeal squamous cell carcinoma (LSCC) over the last three decades, recent studies show conflicting results regarding survival
Primary surgical treatment was administered in 34.5% of early-stage LSCC cases and 27.2% of advanced-stage LSCC cases, respectively
When analyzed according to T-status, disease-specific survival (DSS) ranged from 47.6% (T4 supraglottic LSCC) to 98.1% (T1a glottic LSCC), and disease-free survival (DFS) ranged from 23.0% (T3 glottic LSCC) to 69.1% (T1a glottic LSCC), respectively
Summary
Despite progress in the management of laryngeal squamous cell carcinoma (LSCC) over the last three decades, recent studies show conflicting results regarding survival. In Norway, the estimated age-standardized mortality rate across patients of all ages and both sexes in 2012 was 0.4 per 100,000 for laryngeal cancer compared to 0.7 per 100,000 in the United States [5]. It is essential to consider the highly heterogeneous nature of laryngeal cancer when performing a survival analysis of LSCC. The fact that glottic tumors are diagnosed at an earlier stage compared to supraglottic tumors affects treatment opportunities and prognosis, and argues for survival analysis to be performed according to tumor stage and subsite [6,7,8]. Previous studies, including analyses in Norway, have found females to be more prone to supraglottic cancer [9,11]. Young age, intermediate T-status and supraglottic cancer were found to be negatively associated with the risk of recurrence, which is expected to affect outcome [12]
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