J Cancer 2021; 12(4):1220-1230. doi:10.7150/jca.50404 This issue

Research Paper

Long-term survival trend after primary total laryngectomy for patients with locally advanced laryngeal carcinoma

Zhongyang Lin, M.D.1, Hanqing Lin, M.D.2, Yuqing Chen, M.D.1, Yuanteng Xu, M.D., Ph.D.1, Xihang Chen, M.D.1, Hui Fan, M.D, Ph.D.1, Xiaobo Wu, M.D.1, Xiaoying Ke, M.D.1, Chang Lin, M.D., Ph.D1✉

1. Department of Otolaryngology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
2. Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.
Lin Z, Lin H, Chen Y, Xu Y, Chen X, Fan H, Wu X, Ke X, Lin C. Long-term survival trend after primary total laryngectomy for patients with locally advanced laryngeal carcinoma. J Cancer 2021; 12(4):1220-1230. doi:10.7150/jca.50404. Available from https://www.jcancer.org/v12p1220.htm

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Purpose: To evaluate long-term survival trends after primary total laryngectomy (TL) for locally advanced laryngeal carcinoma (LC).

Methods: A total of 2094 patients diagnosed with locally advanced LC and underwent primary TL (1992-2011, at least 5-year follow-up) in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Besides the traditional overall survival (OS) and cancer-specific survival (CSS) by using Kaplan-Meier curves, the 3-year conditional survival analysis was also performed to describe the long-term trends in these patients. Time-dependent multivariate competing-risk models were constructed to assess the persistent sub-distribution hazard of prognostic factors. Finally, a nomogram was developed to predict conditional cancer-specific survival.

Results: The curves of overall hazard and cancer-specific hazard both quickly reached the apex within the first year since TL, then decreased thereafter. In general, the CS3 steadily increased from within 5 years after TL. In the stratified CS3 analysis, the increments in patients with adverse characteristics were more pronounced. 4 years after TL, the probability of surviving the next year exceeded 90%. The time-dependent multivariate competing-risk models indicated that age and lymph node ratio (LNR) persistently contributed to the cancer-specific outcome. The nomogram based on the competing-risk model was constructed to estimate CSS probability conditional upon 3 years for advanced LC patients having survived 1, 2, and 3 years.

Conclusion: Most patients achieved a substantially improved survival rate after surviving a long period after primary TL. Patients diagnosed at older age and with higher LNR should receive more effective follow-up. The predictive nomogram can provide significant evidence for clinical research and practice.

Keywords: laryngeal carcinoma, locally advanced, laryngectomy, conditional survival, SEER database