TS2016 094 ESLC COSM Poster rev 1-15-16 · The results of the multivariable analysis are shown in...
Transcript of TS2016 094 ESLC COSM Poster rev 1-15-16 · The results of the multivariable analysis are shown in...
From 1992 to 2009, the SEER database identified a total of 5,301 patients meeting the inclusion criteria. The use of radiation therapy increased over time: 59.0% in the 1992 to 1997 cohort; 80.1% in 1998 to 2003, and 82.5% in 2004 to 2009 (p < .001).
Patients who received surgical therapy had better overall survival (OS) than patients who received radiation therapy (p < .001) (Figure 1). The difference in OS between treatment groups remained after stratification by stage (p < 0.001 for Stage I; p = 0.03 for Stage II), as well as by subsite (p < .001). The difference in OS between treatment groups also remained after stratifying by year of diagnosis cohorts (p = 0.02, p = 0.01, and p < 0.001, respectively for each year of diagnosis cohort).
The results of the multivariable analysis are shown in Table 3. Patients who received radiation therapy had worse OS (hazard ratio [HR] 1.29) after adjusting for year of diagnosis, AJCC stage, age, sex, subsite, race, and marital status. Female sex (HR 0.79), glottic subsite (HR 0.46), T1 stage (HR 0.74), and married status (HR 0.67) had positive impacts on OS. Black race (HR 1.25), increased age (HR 1.1 for each year), and 1992 – 1998 year of diagnosis cohort (HR 1.22) had negative impacts on OS.
Objectives: Analyze cumulative survival rates for early stage laryngeal cancer comparing radiation and surgical therapy. The primary independent variable was the mode of therapy (radiation versus surgical therapy.)
Methods: Data extracted from SEER Database. Study cohort included patients with stage I and II laryngeal squamous cell carcinoma between 1992 and 2009. Radiotherapy cohort included patients who received external beam radiation alone; surgical cohort included patients who received surgical resection alone.
Results: A total of 5,301 patients were extracted from the SEER database. Radiation therapy increased over time, from 59.0% in the 1992-1997 cohort, to 80.1% in the 1998 to 2003 cohort, and 82.5% in the 2004 to 2009 cohort (p < .001). Five year overall survival was improved in the surgical cohort- 78.4% vs. 68.7 % (p< 0.001). Multivariable analysis showed that patients who received radiation therapy had worse OS (hazard ration [HR] 1.29) after adjusting for year of diagnosis, AJCC stage, age, sex, subsite, race, and marital status.
Conclusions: The proportion of patients with early stage laryngeal cancer receiving radiation instead of surgery has significantly increased since the publication of the VA Laryngeal Cancer study. We show that the five year overall survival in patients receiving radiation is significantly worse than surgical therapy after adjusting for stage, subsite, and year of diagnosis.
ABSTRACT
METHODS
RESULTS RESULTS
Survival Outcomes in Early Stage Laryngeal Cancer
Haig Panossian, MD and Uchechukwu Megwalu, MDIcahn School of Medicine at Mount Sinai
Data were extracted from the Surveillance, Epidemiology, and End Results (SEER) 18 Database of the National Cancer Institute. The study cohort included patients diagnosed with stage I and stage II laryngeal squamous cell carcinoma between 1992 and 2009. Exclusion criteria included positive nodal status, distant metastasis, multiple primary tumors, medical contraindication for surgery, and cases in which surgery was recommended but was not performed.
The radiotherapy cohort included patients who received external beam radiation alone while the surgical cohort included patients who received surgical resection alone (either endoscopic or open). Three cohorts were examined on the basis of year of diagnosis (1992 - 1997, 1998 -2003, 2004 - 2009.) Race was recorded in the SEER database as “White”; “Black”; “Other: American Indian, Alaska Native, Asian/Pacific Islander”; or “Unknown.” Marital status was grouped as “married” (including common law) or “single” (single-never married, divorced, widowed).
The SEER computer software (SEER*Stat version 8.1.5) was used to extract data from the SEER database. The statistical analysis was performed using IBM SPSS version 20. Survival analysis was performed using Kaplan-Meier analysis. Cox proportional hazards regression model was used for multivariable survival analysis. P value of less than 0.05 was considered statistically significant. This study was exempt from review by the Icahn School of Medicine at Mount Sinai Institutional Review Board because it was conducted using de-identified public data.
1. The use of radiation therapy for treatment of early stage laryngealcancer has increased since 1992.
2. Early stage laryngeal cancer treated with surgical therapy hasimproved survival over treatment with radiation therapy.
3. Stage I disease, glottic subsite, female gender and married status havepositive impacts on overall survival, while black race and age havenegative impacts.
1. Jemal A, Siegel R, Ward E, et al. Cancer statistics, 2007. CA Cancer J Clin. 2007; 57: 43-66.2. The Department of Veterans Affairs Laryngeal Cancer Study Group. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced
laryngeal cancer. N Engl J Med. 1991; 324(24): 1685-90.3. Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med.
2003;349(22):2091-2098.4. National Comprehensive Cancer Network. (2012). NCCN clinical practice guidelines in oncology. Head and Neck Cancers.5. Jones AS, Rish B, Fenton JE, and Husband DJ. The treatment of early laryngeal cancers (T1-T2 NO): surgery or irradiation? Head & Neck 2004; 26: 127-135.6. Hoffman HT, Porter K, Karnell LH, Cooper JS, Weber RS, Langer CJ, Ang K, Gay G, Stewart A, Robinson RA. Laryngeal cancer in the United States: Changes in
Demographics, Patterns of Care, and Survival. Laryngoscope. 2006; supplement.7. Dey P, Arnold D, Wight R, Kelly CG, MCKenzie K. Radiotherapy versus open surgery versus endolaryngeal surgery (with or without laser) for early laryngeal squamous cell
cancer. Cochrane Database of Systematic Reviews 2002, Issue 2.8. Mendenhall WM, Parsons JT, Mancuso AA, Stringer SP, Cassisi NJ. Radiotherapy for squamous cell carcinoma of the supraglottic larynx: an alternative to surgery. Head
Neck. 1996 Jan-Feb;18(1):24-35.9. Spriano G et al. Radiation treatment of early stage supraglottic cancer. Ann Otolaryngol Chir Cervicofac. 1999 May;116(2):66-70.10. Cellai E, Frata P, Magrini SM, Paiar F, Barca R, Fondelli S, Polli C, De Stefani A, Buglione M and Biti G. Radical Radiotherapy for Early Glottic Cancer: Results in a Series
of 1087 Patients from Two Italian Radiation Oncology Centers. I. The Case of T1N0 Disease. Int J Radiation Oncology Biol Phys. 2005; 63(5): 1378-1386. 11. Frata P, Cellai E, Magrini SM, Bonetti B, Vitali E, Tonoli S, Bugione M, Paiar F, Barca R, Fondelli S, Polli C, Livi L and Biti G. Radical Radiotherapy for Early Glottic Cancer:
Results in a Series of 1087 Patients from Two Italian Radiation Oncology Centers. I. The Case of T2N0 Disease. Int J Radiation Oncology Biol Phys. 2005; 63(5): 1387-1394.
12. Arshad H, Jayaprakash V, Gupta V et al. Survival difference between organ preservation surgery and definitive radiotherapy in early supraglottic squamous cell carcinoma. Otolaryngology-Head and Neck Surgery. 2014; 150(2) 237-244.
13. Misono S, Marmor S, Yueh B, and Virnig BA. Treatment and Survival in 10, 429 Patients with Localized Laryngeal Caner: A Population-Based Analysis. Cancer. 2014; 120: 1810-7.
14. Thomas JV, Olsen KD, Neel HB, DeSanto LW, Suman VJ. Early glottic carcinoma treated with open laryngeal procedures. Arch Otolaryngol Head Neck Surg. 1994;120: 264-268.
15. Silver CE, Beitler JJ, Shaha AR, Rinaldo A, Ferlito A. Current trends in initial management of laryngeal cancer: the declining use of open surgery. Eur Arch Otorhinolaryngol. 2009; 266:1333-1352.
16. Surveillance, Epidemiology and End Results (SEER) Program (www.seer.cancer.gov) SEER*Stat Database: Incidence- SEER 18 Regs Research Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2013 Sub (1973-3011 varying) - Linked To County Attributes - Total U.S., 1969-2012 Counties, National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2014 (updated 5/7/2014), based on the November 2013 submission. Accessed March 4, 2015.::Cancer. 2014; 120:1810-1817.
17. Hintz B, Charyulu K, Chandler JR, Sudarsanam A and Garcia C. Randomized Study of Local Control and Survival Following Radical Surgery or Radiation Therapy in Oral and Laryngeal Carcinomas. Journal of Surgical Oncology. 1979; 12: 61-74.
Table 1. Patient Characteristics
Overall (n=5301)
Surgery (n=1070)
Radiation (n=4231) P value
Average Age 63.6 63.3 63.9 0.19
Male Gender
4402 (83.1%) 901 (84.2%) 3501
(82.7%) 0.26
Race <0.001
White 4460 (84.1%) 941 (87.9%) 3519
(83.2%)
Black 673 (12.7%) 90 (8.4%) 583 (13.8%)
Married 3357 (63.3%) 705 (65.9%) 2652
(62.7%) 0.05
T1 Stage 4092 (77.2%) 934 (87.3%) 3158
(74.6%) <0.001
Glottic subsite
4147 (78.2%) 880 (82.2%) 3267
(72.2%) <0.001
Overall SurvivalVariable 5-year P valueOverallSurgery 78.40% <0.001
Radiation 68.70%1992-1997
Surgery 79.60% 0.02Radiation 62.80%
1998-2003Surgery 78.70% 0.01
Radiation 71.20%2004-2009
Surgery 77.80% <0.001Radiation 67.90%
T1 StageSurgery 80.10% <0.001
Radiation 71.70%T2 Stage
Surgery 66.50% 0.03Radiation 59.70%
Glottic SubsiteSurgery 55.00% <0.001
Radiation 47.90%Supraglottic Subsite
Surgery 49.50% <0.001Radiation 33.80%
Variable Coefficient (SE) Wald 𝛘2 HR (95% CI) P valueRadiation Treatment
0.256 (0.060) 17.85 1.29 (1.15-1.45) <0.001
Age 0.054 (0.002) 629.73 1.1 (1.05-1.06) <0.001Cohort1992-1998 0.195 (0.079) 6.03 1.22 (1.04-1.42) 0.0141998-2003 0.042 (0.056) 0.58 1.04 (0.94-1.16 0.45T1 Stage -0.302 (0.061) 24.91 0.74 (0.66-0.83) <0.001
Glottic Subsite -0.788 (0.055) 202.29 0.46 (0.41-0.51) <0.001Female Gender -0.233 (0.062) 13.96 0.79 (0.70-0.90) <0.001
RaceBlack 0.219 (0.067) 10.77 1.25 (1.09-1.42) 0.001Other -0.449 (0.153) 8.55 0.64 (0.47-0.86) 0.003
Married -0.407 (0.047) 73.65 0.67 (0.61-0.73) <0.001
Table 3. Factors Predictive of Overall Survival
Table 2. Univariable Analysis
Figure 1. Five-year Overall Survival on the Basis of Therapy
CONCLUSIONS
REFERENCES