Influential Factors on Survival in Laryngeal Cancer and Treatment Modalities Comparison

Introduction: Laryngeal cancer (LC) is the most common malignancy in otolaryngology, comprising 30-40% of head and neck malignancies. With an increasing incidence worldwide over the past few decades, LC has resulted in substantial strain on the NHS. There have been notable advancements in the treatment of LC over the years, particularly with the adoption of non-surgical methods, which emerged after the 1991 study conducted by the Veterans Affairs. Nevertheless, there has been an increase inmortality rates for head and neck cancer by approximately 15% in the UK over the last decade. This study aimed to evaluate the survival outcomes of patients with LC in our population, considering both the disease stage and treatment modality applied. Methods: Retrospective data were collected from 2015 to 2019 for all patients who were diagnosed with primary LC at NHS Tayside. Univariate and multivariate analyses were performed to determine the factors associated with overall survival (OS) and disease-specific survival (DSS) in LC. Survival analysis using Kaplan-Meier curve was used to compare the treatment modalities in different stages of LC. Results: Patients with advanced LC (stages 3 and 4) had more than 5 times risk of mortality compared to patients with early LC (stage 1 and 2) (DSS: HR 6.10, 95% CI: 1.52-14.61, p = 0.016; OS: HR 5.52, 95% CI: 1.64-13.34, p = 0.017). In patients with stage 4 LC, laryngectomy provides better survival outcomes than chemoradiotherapy (DSS: p = 0.035; OS: p = 0.046). In addition, DSS was double, and OS was 3 times higher for patients who received adjuvant radiotherapy following laryngectomy compared to patients who underwent laryngectomy alone (DSS: p = 0.036; OS: p = 0.032). Conclusion: Our study supports that surgical treatment with adjuvant radiotherapy improves the survival outcomes of advanced LC and should be considered as first-line treatment in patients who are fit for surgery. More prospective studies are needed to determine the optimal treatment approach for advanced LC with consideration of organ function, patient quality of life, and treatment-related morbidity and mortality.