(0651) Functional and Survival Outcomes of T4 Laryngeal Cancer: Primary Laryngectomy Versus Laryngectomy With Adjuvant Therapy

Introduction: The purpose of this study is to investigate the differences in functional and survival outcomes for patients with T4 laryngeal cancer undergoing primary laryngectomy vs laryngectomy with adjuvant therapy.

Methods: This is a multicenter retrospective cohort study utilizing de-identified data from the TriNetX Database in the United States from January 1, 2010 to September 10, 2023 to evaluate differences in functional and survival outcomes for patients with T4 squamous cell carcinoma who underwent either primary laryngectomy or laryngectomy with radiation and/or chemoradiation. Propensity score matching was performed to balance the groups. Functional outcomes including dysphagia, gastrostomy tube dependence, and the need for esophageal dilation, and survival were evaluated between the two groups at 6 months, 1 year, 3 years, 5 years, and 10 years posttreatment. Rates of outcomes were measured by relative risk (RR) with 95% confidence interval (CI).

Results: After propensity score matching, both groups comprised of 88 patients. Laryngectomy with adjuvant therapy was associated with a higher rate of dysphagia early at 6 months (RR: 1.54; 95% CI: 1.01-2.35), later at 1 year (RR: 1.83; 95% CI: 1.30-2.58), and at 5 years posttreatment (RR: 1.58; 95% CI: 1.2-2.09). Patients who also received this treatment also had a higher rate of gastrostomy tube dependence 3 years posttreatment (RR: 1.54; 95% CI: 1.01-2.35). The need for esophageal dilation was similar up to 10 years (RR: 1.5; 95% CI: 0.86-2.62). There was no difference in survival up to 10 years (RR: 1.09; 95% CI: 0.75-1.6).

Conclusions: Laryngectomy with adjuvant therapy was associated with higher rates of dysphagia in the short and long-term, and gastrostomy tube dependence after 3 years. The addition of adjuvant therapy to laryngectomy was not associated with increased survival compared to primary laryngectomy.