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Treatment delay and facility case volume are associated with survival in early‐stage glottic cancer
Author(s) -
Cheraghlou Shayan,
Kuo Phoebe,
Judson Benjamin L.
Publication year - 2017
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26259
Subject(s) - medicine , cancer , proportional hazards model , stage (stratigraphy) , hazard ratio , larynx , retrospective cohort study , radiation therapy , multivariate analysis , survival analysis , univariate analysis , oncology , surgery , confidence interval , paleontology , biology
Objective To identify and compare treatment and system factors associated with survival in early‐stage glottic cancer. Study Design Retrospective study of cases in the Commission on Cancer National Cancer Database. Methods Adult patients with early glottic cancer (stage I or II) diagnosed between January 1, 2004, and December 31, 2012, were included. Demographic, tumor, and survival variables were included in the analyses. Multivariate Cox regressions as well as univariate Kaplan‐Meier analyses were conducted. Results In total, 5,627 patients were included in the study. Treatment factors associated with improved survival included larynx‐preserving surgery alone (hazard ratio [HR] 0.740; P = 0.001) and larynx‐preserving surgery with radiation (HR 0.837; P = 0.010) when compared to radiotherapy alone. System factors associated with worse survival included intermediate‐ (HR 1.123; P = 0.047) or low‐ (HR 1.458; P = 0.017) volume centers; Medicaid (HR 1.882; P < 0.001), Medicare (HR 1.532; P < 0.001), or other government insurance (HR 2.041; P < 0.001); and delay between diagnosis and treatment greater than 100 days (HR 1.605; P = 0.006). Conclusion A number of treatment and system factors were found to be significantly associated with survival when controlling for patient and tumor factors. These may present targets for the improvement of outcomes in early‐stage glottic cancers. Level of Evidence 4. Laryngoscope , 127:616–622, 2017