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

Andrew C. Birkeland, Lauren Beesley, Emily Bellile, Andrew J. Rosko, Rebecca Hoesli, Steven B. Chinn, Andrew G. Shuman, Mark E. Prince, Gregory T. Wolf, Carol R. Bradford, J. Chad Brenner, Matthew E. Spector

Research output: Contribution to journalArticle

13 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)2512-2518
Number of pages7
JournalHead and Neck
Volume39
Issue number12
DOIs
StatePublished - Dec 2017
Externally publishedYes

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Keywords

  • Adult Comorbidity Evaluation-27 (ACE-27)
  • disease-specific survival
  • overall survival
  • recurrent laryngeal cancer
  • salvage laryngectomy

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Birkeland, A. C., Beesley, L., Bellile, E., Rosko, A. J., Hoesli, R., Chinn, S. B., Shuman, A. G., Prince, M. E., Wolf, G. T., Bradford, C. R., Brenner, J. C., & Spector, M. E. (2017). Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma. Head and Neck, 39(12), 2512-2518. https://doi.org/10.1002/hed.24918