Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma.

Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma.

Head Neck. 2017 Sep 30;:

Authors: Birkeland AC, Beesley L, Bellile E, Rosko AJ, Hoesli R, Chinn SB, Shuman AG, Prince ME, Wolf GT, Bradford CR, Brenner JC, Spector ME

Abstract
BACKGROUND: Total laryngectomy remains the treatment of choice for recurrent/persistent laryngeal squamous cell carcinoma (SCC) after radiotherapy (RT) or chemoradiotherapy (CRT). However, despite attempts at aggressive surgical salvage, survival in this cohort remains suboptimal.
METHODS: A prospectively maintained single-institution database was queried for patients undergoing total laryngectomy for recurrent/persistent laryngeal SCC after initial RT/CRT between 1998 and 2015(n = 244). Demographic, clinical, and survival data were abstracted. The Kaplan-Meier survival curves and hazard ratios (HRs) were calculated.
RESULTS: Five-year overall survival (OS) was 49%. Five-year disease-free survival (DFS) was 58%. Independent predictors of OS included severe comorbidity (Adult Comorbidity Evaluation-27 [ACE-27] scale; HR 3.76; 95% confidence interval [CI] 1.56-9.06), and positive recurrent clinical nodes (HR 2.91; 95% CI 1.74-4.88).
CONCLUSION: Severe comorbidity status is the strongest predictor of OS, suggesting that increased attention to mitigating competing risks to health is critical. These data may inform a risk prediction model to allow for focused shared decision making, preoperative health optimization, and patient selection for adjuvant therapies.

PMID: 28963806 [PubMed - as supplied by publisher]

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