International Journal of Head and Neck Surgery

Register      Login

VOLUME 7 , ISSUE 3 ( July-September, 2016 ) > List of Articles


Predictors of Survival in Early-stage Laryngeal Cancer by Treatment Modality

Vikas Mehta, Trisha Thompson, Runhua Shi

Citation Information : Mehta V, Thompson T, Shi R. Predictors of Survival in Early-stage Laryngeal Cancer by Treatment Modality. Int J Head Neck Surg 2016; 7 (3):173-181.

DOI: 10.5005/jp-journals-10001-1284

Published Online: 01-12-2011

Copyright Statement:  Copyright © 2016; The Author(s).



Our investigation attempts to identify factors associated with improved survival for early-stage laryngeal cancer based on primary therapy using the National Cancer Database (NCDB).

Materials and methods

This is a retrospective cohort with data abstracted from the NCDB. Patients with T1 or T2N0M0 laryngeal cancer from 1998 to 2011 who received radiation only, laser surgery, or laser surgery with adjuvant radiation were included. Chi-square analysis was used to assess and investigate the association between treatment and factors. Overall survival (OS) was assessed via Kaplan–Meier method. Log-rank methods were used to determine factors significant for survival, and a multivariable Cox regression model was performed.


There were 14,276 patients from the NCDB eligible for this study. The majority (91.2%) of patients received primary radiation, 4.7% laser resection, and 4.0% laser resection with radiation. Five-year survival for laser surgery was 78.8% [95% confidence interval (CI) 75.5–82.1%] vs 67.2% (95% CI 66.4–68.1%) for radiation alone. Multivariate analysis demonstrated advanced age, increased comorbidities, public or uninsured, T2 stage, supraglottic subsite to be independently associated with worse survival. Treatment with laser only and laser with adjuvant radiation demonstrated a hazard ratio of 0.77 (p = 0.055) and 0.65 (p = 0.001) when compared with primary radiation.

Conclusion and clinical significance

Survival analysis on early-stage glottic patients in the NCDB showed multiple factors to be independently associated with survival. Outcomes based on treatment suggest an improved survival when utilizing endoscopic surgery as the primary treatment modality.

How to cite this article

Mehta V, Thompson T, Shi R. Predictors of Survival in Early-stage Laryngeal Cancer by Treatment Modality. Int J Head Neck Surg 2016;7(3):173-181.

PDF Share
  1. Temporal trends in the treatment of early- and advanced-stage laryngeal cancer in the United States, 1985-2007. Arch Otolaryngol Head Neck Surg 2011 Oct;137(10):1017-1024.
  2. Evidence-based review of treatment options for patients with glottic cancer. Head Neck 2011 Nov;33(11):1638-1648.
  3. Evidence-based practice: management of glottic cancer. Otolaryngol Clin North Am 2012 Oct;45(5):1143-1161.
  4. Comparative evaluation of the effectiveness of radiotherapy, surgery and combined treatment of stage I-II laryngeal cancer (T1-2NoMo) based on the data of a cooperative randomized study. Vestn Otorhinolaryngol 1990 May-Jun; (3):3-7.
  5. Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell cancer. Cochrane Database Syst Rev 2002;(2):CD002027.
  6. The role of laser microsurgery in the treatment of laryngeal cancer. Curr Opin Otolaryngol Head Neck Surg 2007 Apr;15(2):82-88.
  7. What treatment for early-stage glottic carcinoma among adult patients: CO2 endolaryngeal laser excision versus standard fractionated external beam radiation is superior in terms of cost utility? Laryngoscope 2011 Jan;121(1):116-134.
  8. Has radiotherapy become too expensive to be considered a treatment option for early glottic cancer? Head Neck 1997 Dec;19(8):692-700.
  9. Quality of life, functional outcome, and costs of early glottic cancer. Laryngoscope 2003 Jan;113(1):68-76.
  10. Cordectomy by CO2 laser or radiotherapy for small T1a glottic carcinomas: costs, local control, survival, quality of life, and voice quality. Head Neck 2007 Feb;29(2):128-136.
  11. Voice outcome in T1a midcord glottic carcinoma: laser surgery vs radiotherapy. Arch Otolaryngol Head Neck Surg 2008 Sep;134(9):965-972.
  12. Voice-related quality of life in T1 glottic cancer: irradiation versus endoscopic excision. Annals Otol Rhinol Laryngol 2006 Aug;115(8):581-586.
  13. Health status and voice outcome after treatment for T1a glottic carcinoma. Eur Arch Otorhinolaryngol 2004 Nov;261(10):534-540.
  14. Voice quality after treatment for T1a glottic carcinoma-radiotherapy versus laser cordectomy. Acta Oncologica 2004;43(3):284-289.
  15. Oncologic and voice outcomes after treatment of early glottic cancer: transoral laser microsurgery versus radiotherapy. J Otolaryngol Head Neck Surgery [Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale] 2012 Dec;41(6):381-388.
  16. Euro Arch Otorhinolaryngol 2013 Jul;270(7):2079-2087.
  17. Comparison of early oncological results of diode laser surgery with radiotherapy for early glottic carcinoma. Otolaryngol Head Neck Surg 2014 May;150(5):818-823.
  18. Quality of life and voice assessment in patients with early-stage glottic cancer. Head Neck 2015 Mar;37(3):340-346.
  19. Endoscopic treatment of cT2 glottic carcinoma: prognostic impact of different pT subcategories. Ann Otol Rhinol Laryngol 2005 Aug;114(8):579-586.
  20. Analysis of recurrences in 322 Tis, T1, or T2 glottic carcinomas treated by carbon dioxide laser. Ann Otol Rhinol Laryngol 2004 Nov;113(11):853-858.
  21. Impact of treating facilities' volume on survival for early-stage laryngeal cancer. Head Neck 2009 Sep;31(9):1137-1143.
  22. T1 glottic carcinoma: do comorbidities, facility characteristics, and sociodemographics explain survival differences across treatment? Otolaryngol Head Neck Surgery 2015 May;152(5):856-862.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.