(A646) Transoral Laser Microsurgery vs Radiotherapy for Aryepiglottic Fold Squamous Cell Carcinoma: A National Database Study

Introduction: Aryepiglottic fold squamous cell carcinoma (SCC) has traditionally displayed an aggressive growth pattern, often presenting at late stages, with non-surgical treatment frequently being preferred due to poor functional outcomes associated with extensive laryngopharyngeal resections. With the increased use of transoral laser microsurgery (TLM) in recent years for targeted surgical resection of early-stage SCC, we sought to analyze survival data for patients with T1/T2 aryepiglottic fold SCC undergoing primary surgery with TLM compared to definitive radiation.

Methods: Patients from the National Cancer Database (NCDB) with cT1/cT2 aryepiglottic fold SCC undergoing definitive treatment from 2004-2018 were analyzed. The primary outcome was overall survival for primary surgery (+/- adjuvant treatment, PS) versus primary radiation (+/- chemotherapy, RT +/- C).

Results: In total, 16,921 patients fit inclusion criteria with a median age of 63 (IQR 56-70) and 65.2% male population with no statistically significant differences in age, sex, and comorbidities between the PS and RT +/- C groups (two-sample T-test and Mann-Whitney U-test). The median survival time for patients undergoing PS with TLM was 82.6 months (IQR 32.1-164.5) versus 52.7 months for RT +/- C (95% CI 44.9-50.7, p< 0.001). Mantel-Haenszel survival analysis revealed a lower risk of death with PS with TLM compared to RT +/- C when controlling for age, sex, medical comorbidities, and tumor stage (RR 0.67, 95% CI 0.60-0.74). Multivariable Cox proportional hazards survival analysis also demonstrated that PS was associated with a lower chance of death (HR 0.77, 95% CI 0.66-0.92) compared to RT +/- C, though positive margins in the TLM group did not significantly increase risk of death (HR 1.02, 95% CI 0.99-1.05).

Conclusions: While historically underutilized, primary surgery with TLM for early-stage aryepiglottic fold SCC presents a promising alternative to traditional RT +/- C regimens. However, a prospective analysis of functional swallowing and speech outcomes is necessary to determine if the functional outcomes of TLM reflect the survival benefits.