Failed larynx preservation and survival in patients with advanced larynx cancer.

Autor: Nocon CC; Division of Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA. Electronic address: cnocon@northshore.org., Yesensky J; Section of Otolaryngology-Head and Neck Surgery, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA. Electronic address: jayesensky@ucdavis.edu., Ajmani GS; Pritzker School of Medicine, University of Chicago, 924 E. 57(th) Street, Chicago, IL 60637, USA. Electronic address: gajmani@uchicago.edu., Bhayani MK; Division of Otolaryngology-Head and Neck Surgery, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA. Electronic address: mbhayani@northshore.org.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2019 Jul - Aug; Vol. 40 (4), pp. 542-546. Date of Electronic Publication: 2019 Apr 22.
DOI: 10.1016/j.amjoto.2019.04.014
Abstrakt: Purpose: To evaluate the survival benefit of total laryngectomy (TL) after induction chemotherapy in locally advanced laryngeal cancer patients.
Materials and Methods: This is a retrospective study utilizing the National Cancer Database, which captures >80% of newly diagnosed head and neck squamous cell carcinoma cases in the United States. We included patients diagnosed with advanced stage laryngeal squamous cell carcinoma between 2004 and 2013 (n = 5649) who received either TL (n = 4113; 72.8%) or induction chemotherapy followed by either radiation therapy (n = 1431) or TL (n = 105). Kaplan-Meier curves and Cox proportional hazards regression were used to evaluate overall survival. A Cox regression model was computed to examine how the prognostic impact of treatment differed by clinical stage.
Results: In multivariable analysis, when compared to patients receiving TL alone, those receiving induction chemotherapy followed by TL experienced no significant difference in survival (HR 0.85, 95% CI 0.63-1.13), while those receiving induction chemotherapy followed by radiation experienced poorer survival (HR 1.15, 95% CI 1.06-1.26). Induction chemotherapy followed by TL was associated with improved survival compared to induction chemotherapy and radiation (P = .042). Among patients with T4a tumors, TL (P < .001) and induction chemotherapy followed by TL (P = .002) were both associated with improved survival compared to induction chemotherapy and radiation. There were no survival differences between TL and induction chemotherapy followed by TL (HR 0.76, 95% CI 0.52-1.10).
Conclusions: Larynx preservation may be attempted without compromising survival in patients with locally advanced larynx cancer who fail induction chemotherapy and undergo TL.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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