Treatment of Biopsy-Proven Laryngeal Squamous Cell Carcinoma In Situ

Abstract

Objective

To investigate the impact of clinical surveillance, primary radiotherapy, and primary surgery on overall survival (OS) in laryngeal carcinoma in situ (Cis).

Methods

The 2006–2020 National Cancer Database was queried for adults with a biopsy-proven diagnosis of laryngeal Cis. Multivariable binary logistic and Cox proportional hazards regression models were implemented.

Results

Of 3567 unique patients satisfying inclusion criteria, 514 (14.4%) underwent clinical surveillance, 1074 (30.1%) underwent primary radiotherapy, and 1979 (55.5%) underwent primary surgery. Receiving treatment at an academic/research facility was associated with higher odds of undergoing primary surgery compared to primary radiotherapy. Among 646 patients undergoing primary surgery with known pT classification and margins, 570 (76.6%) had pTis and NSM and 174 (23.4%) had pT1 and/or PSM. 5-year OS of clinical surveillance, primary radiotherapy, and primary surgery was 73%, 81%, and 86%, respectively (p < 0.001). Patients undergoing primary surgery with invasive or residual disease (i.e., pT1 and/or PSM) had similar 5-year OS as those without (84% vs. 88%, p = 0.057). Compared with primary radiotherapy, clinical surveillance (aHR 1.29, 95% CI 1.06–1.57, p = 0.003) was associated with worse OS, and primary surgery (aHR 0.80, 95% CI 0.69–0.92, p = 0.003) was associated with higher OS.

Conclusion

Primary surgery is associated with higher OS than clinical surveillance and primary radiotherapy among patients with laryngeal Cis.

Level of Evidence

4.