Risk Factors for Functional Outcomes in Advanced Laryngeal Squamous Cell Carcinoma

Laryngoscope. 2023 Mar;133(3):594-600. doi: 10.1002/lary.30166. Epub 2022 May 25.


Objective: Chemoradiation for patients with laryngeal squamous cell carcinoma (SCC) may achieve organ preservation, but appropriate patient selection remains unknown. This study investigates pre-treatment risk factors associated with functional and survival outcomes after radiation-based therapy in patients with advanced laryngeal SCC.

Methods: A retrospective cohort study was performed on 75 adult patients with stage III or IV laryngeal SCC receiving definitive radiation-based therapy from 1997 to 2016 at a tertiary care center. Tracheostomy and gastrostomy dependence were the primary functional outcomes. Multivariable logistic regressions were performed to evaluate relationships between pre-treatment factors and tracheostomy and gastrostomy dependence. Time-to-event analyses were performed to determine risk factors associated with overall survival.

Results: Among 75 patients included in the analysis, 30 (40%) patients were tracheostomy dependent and 31 (41%) were gastrostomy tube dependent. The median length of follow-up was 31 months (range = 1 to 142 months). Pre-treatment tracheostomy was a significant predictor of post-treatment tracheostomy (aOR = 13.9, 95% CI = 3.35 to 57.5) and moderate-severe comorbidity was a significant predictor of post-treatment gastrostomy dependence (aOR = 2.96, 95% CI = 1.04 to 8.43). The five-year overall survival was 51% (95% CI = 38 to 64%). Pre-treatment gastrostomy tube dependence was associated with an increased risk of death (aHR = 2.45, 95% CI = 1.09 to 5.53).

Conclusions: Baseline laryngeal functional status and overall health in advanced laryngeal SCC are associated with poor functional outcomes after radiation-based therapy, highlighting the importance of patient selection when deciding between surgical and non-surgical treatment plans. Laryngoscope, 133:594-600, 2023.

Keywords: chemoradiation; functional outcomes; gastrostomy; laryngeal squamous cell carcinoma; tracheostomy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Carcinoma, Squamous Cell* / pathology
  • Head and Neck Neoplasms*
  • Humans
  • Laryngeal Neoplasms* / pathology
  • Retrospective Studies
  • Risk Factors
  • Squamous Cell Carcinoma of Head and Neck
  • Treatment Outcome