PMID- 34609937
OWN - NLM
STAT- MEDLINE
DCOM- 20220803
LR  - 20220805
IS  - 1097-6817 (Electronic)
IS  - 0194-5998 (Linking)
VI  - 167
IP  - 2
DP  - 2022 Aug
TI  - Patterns of Failure After Definitive Treatment of T4a Larynx Cancer.
PG  - 274-285
LID - 10.1177/01945998211049211 [doi]
AB  - OBJECTIVE: Recurrence is known to predict laryngeal squamous cell cancer (LSCC) 
      survival. Recurrence patterns in T4a LSCC are poorly characterized and represent 
      a possible explanation for observed survival discrepancies by treatment rendered. 
      STUDY DESIGN: Retrospective database review. SETTING: Veterans Affairs national 
      database. METHODS: Patients with T4a LSCC between 2000 and 2017 were identified 
      and stratified by treatment (chemoradiotherapy [CRT] vs total laryngectomy + neck 
      dissection + adjuvant therapy [surgical]). Primary outcomes were locoregional and 
      distant recurrence. Secondary outcomes of overall mortality, larynx cancer 
      mortality, and noncancer mortality were evaluated in Cox and Fine-Gray models. 
      RESULTS: A total of 1043 patients had comparable baseline demographics: 438 in 
      the CRT group and 605 in the surgical group. Patients undergoing CRT had higher 
      proportions of node positivity (64.6% vs 53.1%, P < .001). Locoregional and 
      distant recurrence were less common in the surgical group (23.0% vs 37.2%, P < 
      .001; 6.8% vs 13.3%, P < .001, respectively); however, distant metastatic rates 
      did not differ within the N0 subgroup (P = .722). On multivariable regression, 
      surgery demonstrated favorable locoregional recurrence (hazard ratio [HR], 0.49; 
      95% CI, 0.39-0.62; P < .001), distant recurrence (HR, 0.47; 95% CI, 0.31-0.71; P 
      < .001), overall mortality (HR, 0.75; 95% CI, 0.64-0.87; P < .001), and larynx 
      cancer mortality (HR, 0.69; 95% CI, 0.56-0.85; P < .001). CONCLUSION: T4a LSCC 
      survival discrepancies between surgical and nonsurgical treatment are influenced 
      by varying recurrence behaviors. Surgery was associated with superior disease 
      control and improved survival. Beyond the known benefit in locoregional control 
      with surgery, there may be a protective effect on distant recurrence that depends 
      on regional disease burden.
FAU - Voora, Rohith S
AU  - Voora RS
AUID- ORCID: 0000-0001-9242-844X
AD  - School of Medicine, University of California San Diego, San Diego, California, 
      USA.
AD  - Division of Otolaryngology-Head and Neck Surgery, University of California San 
      Diego, San Diego, California, USA.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
FAU - Panuganti, Bharat A
AU  - Panuganti BA
AUID- ORCID: 0000-0003-1149-9532
AD  - Division of Otolaryngology-Head and Neck Surgery, University of California San 
      Diego, San Diego, California, USA.
AD  - Moores Cancer Center, La Jolla, California, USA.
FAU - Flagg, Mitchell
AU  - Flagg M
AUID- ORCID: 0000-0002-9242-6476
AD  - School of Medicine, University of California San Diego, San Diego, California, 
      USA.
AD  - Division of Otolaryngology-Head and Neck Surgery, University of California San 
      Diego, San Diego, California, USA.
FAU - Nelson, Tyler
AU  - Nelson T
AD  - School of Medicine, University of California San Diego, San Diego, California, 
      USA.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Department of Radiation Medicine and Applied Sciences, School of Medicine, 
      University of California San Diego, La Jolla, California, USA.
FAU - Kotha, Nikhil V
AU  - Kotha NV
AUID- ORCID: 0000-0001-9737-5033
AD  - School of Medicine, University of California San Diego, San Diego, California, 
      USA.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Department of Radiation Medicine and Applied Sciences, School of Medicine, 
      University of California San Diego, La Jolla, California, USA.
FAU - Qiao, Edmund M
AU  - Qiao EM
AUID- ORCID: 0000-0003-2185-9685
AD  - School of Medicine, University of California San Diego, San Diego, California, 
      USA.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Department of Radiation Medicine and Applied Sciences, School of Medicine, 
      University of California San Diego, La Jolla, California, USA.
FAU - Qian, Alexander S
AU  - Qian AS
AUID- ORCID: 0000-0002-0599-2411
AD  - School of Medicine, University of California San Diego, San Diego, California, 
      USA.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Department of Radiation Medicine and Applied Sciences, School of Medicine, 
      University of California San Diego, La Jolla, California, USA.
FAU - Kumar, Abhishek
AU  - Kumar A
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Department of Radiation Medicine and Applied Sciences, School of Medicine, 
      University of California San Diego, La Jolla, California, USA.
FAU - Stewart, Tyler F
AU  - Stewart TF
AD  - Moores Cancer Center, La Jolla, California, USA.
AD  - Divisions of Hematology-Oncology and Blood and Marrow Transplantation, University 
      of California San Diego, San Diego, California, USA.
FAU - Rose, Brent
AU  - Rose B
AUID- ORCID: 0000-0002-3197-9552
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Moores Cancer Center, La Jolla, California, USA.
AD  - Department of Radiation Medicine and Applied Sciences, School of Medicine, 
      University of California San Diego, La Jolla, California, USA.
FAU - Califano, Joseph
AU  - Califano J
AUID- ORCID: 0000-0002-4715-6761
AD  - Division of Otolaryngology-Head and Neck Surgery, University of California San 
      Diego, San Diego, California, USA.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Moores Cancer Center, La Jolla, California, USA.
FAU - Weissbrod, Philip A
AU  - Weissbrod PA
AUID- ORCID: 0000-0001-7977-6925
AD  - Division of Otolaryngology-Head and Neck Surgery, University of California San 
      Diego, San Diego, California, USA.
AD  - Moores Cancer Center, La Jolla, California, USA.
FAU - Mell, Loren K
AU  - Mell LK
AUID- ORCID: 0000-0003-2277-6080
AD  - Moores Cancer Center, La Jolla, California, USA.
AD  - Department of Radiation Medicine and Applied Sciences, School of Medicine, 
      University of California San Diego, La Jolla, California, USA.
FAU - Orosco, Ryan K
AU  - Orosco RK
AUID- ORCID: 0000-0002-7885-4327
AD  - Division of Otolaryngology-Head and Neck Surgery, University of California San 
      Diego, San Diego, California, USA.
AD  - Veterans Affairs San Diego Healthcare System, San Diego, California, USA.
AD  - Moores Cancer Center, La Jolla, California, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20211005
PL  - England
TA  - Otolaryngol Head Neck Surg
JT  - Otolaryngology--head and neck surgery : official journal of American Academy of 
      Otolaryngology-Head and Neck Surgery
JID - 8508176
SB  - IM
MH  - *Head and Neck Neoplasms/surgery
MH  - Humans
MH  - *Laryngeal Neoplasms/pathology
MH  - Laryngectomy
MH  - Neoplasm Recurrence, Local/pathology
MH  - Neoplasm Staging
MH  - Retrospective Studies
MH  - Squamous Cell Carcinoma of Head and Neck/pathology
OTO - NOTNLM
OT  - T4a larynx cancer
OT  - Veterans Affairs
OT  - adjuvant therapy
OT  - chemoradiation
OT  - recurrence
OT  - total laryngectomy
EDAT- 2021/10/06 06:00
MHDA- 2022/08/04 06:00
CRDT- 2021/10/05 17:15
PHST- 2021/10/06 06:00 [pubmed]
PHST- 2022/08/04 06:00 [medline]
PHST- 2021/10/05 17:15 [entrez]
AID - 10.1177/01945998211049211 [doi]
PST - ppublish
SO  - Otolaryngol Head Neck Surg. 2022 Aug;167(2):274-285. doi: 
      10.1177/01945998211049211. Epub 2021 Oct 5.