Aman M. Patel, Afash Haleem, Praneet C. Kaki, Rohini Bahethi, Soly Baredes, Richard Chan Woo Park
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Kaplan–Meier, multivariable binary logistic, and Cox proportional hazards regression models were implemented.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Among 2997 patients with consideration(s) for adjuvant radiotherapy (aRT) (i.e., pT3-4, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and/or positive surgical margins [PSM]), 1176 (39.2%) did not undergo adjuvant therapy and were considered to have missed aRT. Among 992 patients with consideration(s) for adjuvant chemoradiotherapy (aCRT) (i.e., pENE and/or PSM), 169 (17.0%) underwent aRT alone and were considered to have missed aCRT. Older age and increased distance to the reporting facility were associated with higher adjusted odds of both missed aRT (<i>p</i> < 0.001) and missed aCRT (<i>p</i> < 0.025). Patients with pENE only (<i>N</i> = 343, 57.6%) and pENE and PSM (<i>N</i> = 96, 56.8%) underwent aCRT more frequently than those with PSM only (<i>N</i> = 97, 42.5%) (<i>p</i> < 0.001). Missed aRT was associated with worse OS among 2005 patients with consideration(s) for aRT alone (i.e., pT3-4, pN2-3 classification, and/or LVI without pENE or PSM) (aHR 1.23, 95% CI 1.05–1.44, <i>p</i> = 0.011) and among 992 patients with consideration(s) for aCRT (aHR 1.85, 95% CI 1.52–2.24, <i>p</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Missed aRT following upfront laryngectomy for LSCC occurs frequently and portends worse OS. Identifying patients at risk of off-guideline management may create opportunities for quality improvement in the multidisciplinary care of patients undergoing upfront laryngectomy for LSCC.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>4.</p>\n </section>\n </div>","PeriodicalId":48529,"journal":{"name":"Laryngoscope Investigative Otolaryngology","volume":"10 5","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70276","citationCount":"0","resultStr":"{\"title\":\"Missed Adjuvant Therapy Following Upfront Laryngectomy for Laryngeal Squamous Cell Carcinoma\",\"authors\":\"Aman M. Patel, Afash Haleem, Praneet C. Kaki, Rohini Bahethi, Soly Baredes, Richard Chan Woo Park\",\"doi\":\"10.1002/lio2.70276\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Objective</h3>\\n \\n <p>To investigate adjuvant therapy considerations, utilization, and associated overall survival (OS) following upfront laryngectomy for laryngeal squamous cell carcinoma (LSCC).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>The 2010 to 2017 National Cancer Database was retrospectively reviewed for patients undergoing upfront laryngectomy (<i>N</i> = 3360). Kaplan–Meier, multivariable binary logistic, and Cox proportional hazards regression models were implemented.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Among 2997 patients with consideration(s) for adjuvant radiotherapy (aRT) (i.e., pT3-4, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and/or positive surgical margins [PSM]), 1176 (39.2%) did not undergo adjuvant therapy and were considered to have missed aRT. Among 992 patients with consideration(s) for adjuvant chemoradiotherapy (aCRT) (i.e., pENE and/or PSM), 169 (17.0%) underwent aRT alone and were considered to have missed aCRT. Older age and increased distance to the reporting facility were associated with higher adjusted odds of both missed aRT (<i>p</i> < 0.001) and missed aCRT (<i>p</i> < 0.025). Patients with pENE only (<i>N</i> = 343, 57.6%) and pENE and PSM (<i>N</i> = 96, 56.8%) underwent aCRT more frequently than those with PSM only (<i>N</i> = 97, 42.5%) (<i>p</i> < 0.001). Missed aRT was associated with worse OS among 2005 patients with consideration(s) for aRT alone (i.e., pT3-4, pN2-3 classification, and/or LVI without pENE or PSM) (aHR 1.23, 95% CI 1.05–1.44, <i>p</i> = 0.011) and among 992 patients with consideration(s) for aCRT (aHR 1.85, 95% CI 1.52–2.24, <i>p</i> < 0.001).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Missed aRT following upfront laryngectomy for LSCC occurs frequently and portends worse OS. Identifying patients at risk of off-guideline management may create opportunities for quality improvement in the multidisciplinary care of patients undergoing upfront laryngectomy for LSCC.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>4.</p>\\n </section>\\n </div>\",\"PeriodicalId\":48529,\"journal\":{\"name\":\"Laryngoscope Investigative Otolaryngology\",\"volume\":\"10 5\",\"pages\":\"\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2025-10-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/lio2.70276\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Laryngoscope Investigative Otolaryngology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/lio2.70276\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Laryngoscope Investigative Otolaryngology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/lio2.70276","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的探讨喉部鳞状细胞癌（LSCC）术前切除后辅助治疗的考虑、使用和相关的总生存率（OS）。方法回顾性分析2010年至2017年国家癌症数据库中接受喉前切除术的患者（N = 3360）。采用Kaplan-Meier、多变量二元logistic和Cox比例风险回归模型。结果在考虑辅助放疗（aRT） （pT3-4、pN2-3分型、淋巴血管侵犯、病理性结外延伸（pENE）和/或手术缘阳性[PSM]）的2997例患者中，1176例（39.2%）未接受辅助治疗，被认为错过了aRT。在考虑辅助放化疗（aCRT）（即pENE和/或PSM）的992例患者中，169例（17.0%）单独接受了aRT治疗，被认为错过了aCRT。年龄越大和距离报告机构的距离越远，aRT漏诊（p < 0.001）和aCRT漏诊（p < 0.025）的调整后几率越高。单纯pENE患者（N = 343, 57.6%）和pENE合并PSM患者（N = 96, 56.8%）接受aCRT的频率高于单纯PSM患者（N = 97, 42.5%） （p < 0.001）。在考虑单独接受aRT治疗（即pT3-4、pN2-3分类和/或LVI不含pENE或PSM）的2005例患者（aHR 1.23, 95% CI 1.05-1.44, p = 0.011）和考虑接受aCRT治疗的992例患者（aHR 1.85, 95% CI 1.52-2.24, p < 0.001）中，错过aRT治疗与较差的OS相关。结论喉鳞癌术前喉切除术后aRT漏诊发生率高，预后较差。识别有偏离指南管理风险的患者，可能为LSCC术前喉切除术患者的多学科护理质量改善创造机会。证据级别4。
Missed Adjuvant Therapy Following Upfront Laryngectomy for Laryngeal Squamous Cell Carcinoma
Objective
To investigate adjuvant therapy considerations, utilization, and associated overall survival (OS) following upfront laryngectomy for laryngeal squamous cell carcinoma (LSCC).
Methods
The 2010 to 2017 National Cancer Database was retrospectively reviewed for patients undergoing upfront laryngectomy (N = 3360). Kaplan–Meier, multivariable binary logistic, and Cox proportional hazards regression models were implemented.
Results
Among 2997 patients with consideration(s) for adjuvant radiotherapy (aRT) (i.e., pT3-4, pN2-3 classification, lymphovascular invasion, pathologic extranodal extension (pENE), and/or positive surgical margins [PSM]), 1176 (39.2%) did not undergo adjuvant therapy and were considered to have missed aRT. Among 992 patients with consideration(s) for adjuvant chemoradiotherapy (aCRT) (i.e., pENE and/or PSM), 169 (17.0%) underwent aRT alone and were considered to have missed aCRT. Older age and increased distance to the reporting facility were associated with higher adjusted odds of both missed aRT (p < 0.001) and missed aCRT (p < 0.025). Patients with pENE only (N = 343, 57.6%) and pENE and PSM (N = 96, 56.8%) underwent aCRT more frequently than those with PSM only (N = 97, 42.5%) (p < 0.001). Missed aRT was associated with worse OS among 2005 patients with consideration(s) for aRT alone (i.e., pT3-4, pN2-3 classification, and/or LVI without pENE or PSM) (aHR 1.23, 95% CI 1.05–1.44, p = 0.011) and among 992 patients with consideration(s) for aCRT (aHR 1.85, 95% CI 1.52–2.24, p < 0.001).
Conclusion
Missed aRT following upfront laryngectomy for LSCC occurs frequently and portends worse OS. Identifying patients at risk of off-guideline management may create opportunities for quality improvement in the multidisciplinary care of patients undergoing upfront laryngectomy for LSCC.
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