Importance: Laryngeal cancer is one of the most common head and neck malignancies. Treatment with surgery or radiation is generally felt to have equal outcomes; however, the impact of where patients are treated is not well understood.
Objective: The aims of this study include: 1) Determine how treatment type was associated with survival of early-stage laryngeal cancer; and 2) Determine how treatment variation at Commission on Cancer hospital types was associated with survival.
Study Design: A retrospective cohort of cases diagnosed with T1N0M0 and T2N0M0 squamous cell carcinoma of the larynx from 2004-2015 from the NCDB.
Methods: Inclusion of all primary early-stage laryngeal cancer cases with appropriate ICD-0-3 codes that received treatment with curative intent including surgery, radiation or chemoradiation. Descriptive analysis was performed. We calculated overall survival as the time from diagnosis to either date of death due to any cause or censoring. Kaplan-Meier all-cause survival plots were constructed, and log-rank p-values were calculated. Hazard ratios (HR) for the independent effects of treatment modality and treatment facility type with overall survival were estimated by Cox proportional hazards regression.
Results: Most early-stage laryngeal tumors were treated with radiation therapy (n = 11,139; 78%). Surgery was used at academic hospitals more frequently than non-academic facilities (22% vs. 6%, respectively). Kaplan-Meier curves for laryngeal cancer showed improved survival for patients treated with surgery at an academic hospital. Multivariate analysis for the individual subsites of the larynx revealed similar survival for glottic cancer cases treated with surgery or radiation. Patients with supraglottic cancer treated with surgery had better survival (HR, 0.72; 95% CI, 0.58 to 0.83) compared to radiation therapy even after adjustment for comorbidities. Regardless of subsite or treatment facility type, chemoradiation was associated with poor outcomes. Patients who received care at an academic facility had better outcomes (overall HR, 0.73; 95% CI, 0.65 to 0.81 and glottic specific HR, 0.68; 95% CI, 0.59 to 0.79) compared with those patients treated at community cancer programs. The use of surgery was associated with improved survival at both academic and community hospitals.
Conclusion: This study represents the largest and most current analysis of early-stage laryngeal cancer treatment trends and factors associated with overall survival. Radiation continues to be the predominant treatment option in the United States. However, surgical management is a growing entity at academic hospitals. Care at an academic facility was associated with improved outcomes regardless of treatment type. These findings suggest that quality improvement studies and measures need to be implemented to better care for patients with early-stage laryngeal cancer.