Survival prediction and treatment strategies for patients with advanced laryngeal carcinoma: a population-based study

Int J Clin Oncol. 2020 Aug;25(8):1483-1491. doi: 10.1007/s10147-020-01688-9. Epub 2020 May 27.

Abstract

Background: This study aimed at exploring high-risk factors associated with survival outcomes in patients with advanced primary laryngeal carcinoma and at developing and validating a survival-predicting model to help to select the appropriate treatment for each patient.

Methods: Data of patients with advanced primary laryngeal cancer in 2003-2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. High-risk factors were identified and integrated to build a nomogram, which was internally validated using bootstrap and externally validated with a patient cohort from China. The impact of various treatments was examined on model-defined high-, moderate- and low-risk patient groups, respectively.

Results: A total of 6070 patients were analyzed. Patients' age, gender, tumor T stage, N stage, and differentiation grade were recognized and integrated into the model. The concordance index of this model (0.602) was significantly higher than that of the TNM staging system (0.547). The calibration curve showed a good agreement between model-predicted and actual survival outcomes. Patients were categorized into three different subgroups with incremental risks of overall mortality. The roles of three treatment strategies in these subgroups are varied.

Conclusion: In this large SEER-based study, we established a practical model to predict overall survival for patients with advanced primary laryngeal cancer. For patients identified as high-risk and moderate-risk, surgery plus adjuvant therapy is recommended, while for patients in the low-risk group, surgery alone plus regular re-examination is recommended as the primary treatment strategy.

Keywords: Locally advanced laryngeal carcinoma; Nomogram; Prognosis; Treatment.

MeSH terms

  • Aged
  • Calibration
  • Chemotherapy, Adjuvant
  • China
  • Cohort Studies
  • Combined Modality Therapy
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Laryngeal Neoplasms / mortality*
  • Laryngeal Neoplasms / pathology
  • Laryngeal Neoplasms / surgery
  • Laryngeal Neoplasms / therapy*
  • Male
  • Middle Aged
  • Nomograms*
  • Reproducibility of Results
  • Risk Factors
  • SEER Program