(A534) Demographics, Management, and Outcomes of Laryngeal Squamous Cell Carcinoma: An NCDB Analysis 2004-2021

Introduction: Landmark studies have suggested that chemoradiation-based management strategies can preserve the larynx without decreasing survival compared to laryngectomy. This study aims to provide an update on laryngeal cancer demographics, treatment, and survival, as there has been a shift in the management of advanced larynx cancer towards nonsurgical management, but with a concomitant increase in case-fatality rate.

Methods: This is a retrospective database review of laryngeal squamous cell carcinoma (LSCC) cases in the National Cancer Database (NCDB) 2004-2021. Univariate analyses (chi-square tests, Mann-Kendall test) were used to assess trends in demographics, treatment modalities, and survival for LSCC patients according to overall staging, site of primary cancer, and specific TNM classification.

Results: 113,152 patients (79.9% male, 77.5% White, 55.6% with glottic cancer, 36.5% with Stage I and 22.8% with Stage IV) with LSCC were queried for the years 2004-2021. The whole cohort's 3-year survival was stable from 2004-2018 (p=0.275), but patients with stage I (p=0.01) LSCC had a decreasing 3-year survival rate while patients with stage IV (p < 0.001) had an increasing 3-year survival rate. There was an increasing proportion of patients diagnosed with Stage IV LSCC and a decreasing proportion of patients diagnosed with stage I LSCC (p < 0.001). The proportion of patients in the overall cohort undergoing surgery with adjuvant radiation decreased from 2006-2021 (p < 0.001) but among patients with T4 LSCC, this proportion increased (p < 0.001). Patients with T4 LSCC who underwent surgery with adjuvant radiation had greater five-year survival than patients who had surgery alone or CRT alone (p < 0.001).

Conclusions: Treatment outcomes for larynx cancer on average have been unchanged over the past 20 years but subgroup analysis demonstrated worsening outcomes for early stage patients and improving outcomes for advanced stage patients. An increased use of upfront surgery among patients with T4 LSCC has coincided with an improving three-year overall survival for this cohort.