Early‐Stage Glottic Carcinoma in the United States: Demographics and Treatment Choice

Abstract

Objective Limited investigation of factors potentially contributing to treatment choice in early‐stage glottic carcinoma (EGC) has been performed with large‐scale data. The National Cancer Database (NCDB) represents >72% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC. Methods The NCDB was queried for all cases of T1‐2 N0 M0 glottic carcinoma from 2004 to 2016. We used multivariable logistic regression analysis to examine factors associated with first‐line treatment modality: radiation therapy (RT) versus surgery. All reported odds ratios (OR) were adjusted for age, gender, race, insurance, residence in a metropolitan area, region, and facility volume. Results 34,991 EGC patients received treatment: 6,687 (19%) surgery; 20,289 (58%) RT; and 8,015 (23%) surgery and RT. OR for receiving RT (vs. surgery alone) were >2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7]), treatment at non‐academic facilities (OR 2.8, [95%CI: 2.6, 3.0]), and shorter travel distances to treatment centers (OR 2.2, [95%CI: 2.0, 2.4]). Surgery was more likely with treatment in the western US, higher income, private insurance, living in a metropolitan (vs. non‐metropolitan) area, female gender, older age, and low facility volume. Hispanic ethnicity, education level, and race were not associated with treatment type in the multivariable model. Conclusion Most patients in the NCDB receive first‐line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility characteristics. Level of Evidence 4 Laryngoscope, 133:901–907, 2023

Patterns of Care for T1 Glottic Squamous Cell Carcinomas from 2004–2020

“…14,17,18,21,22,29 Additionally, apart from voice outcomes, it is possible that limitations of consultation with fellowship-trained head and neck surgeons or laryngologists impedes increased utilization of TLM over open surgery. 27,30 This point may be supported by our multivariable analysis which found that physicians at non-academic centers-a less popular appointment choice for otolaryngology fellowship graduates 31 -were less likely to perform surgery first. Another possibility is the involvement of the anterior commissure and patient factors that may limit adequate exposure for a transoral approach.…”

“…However, there are many studies positing no difference in voice outcomes for either treatment, or even better outcomes for RT over surgery 14,17,18,21,22,29 . Additionally, apart from voice outcomes, it is possible that limitations of consultation with fellowship‐trained head and neck surgeons or laryngologists impedes increased utilization of TLM over open surgery 27,30 . This point may be supported by our multivariable analysis which found that physicians at non‐academic centers—a less popular appointment choice for otolaryngology fellowship graduates 31 —were less likely to perform surgery first.…”

“…26 Additionally, a recent study by Friedman et al described the demographics of T1 and T2 glottic SCC using NCDB data from 2004-2016, and showed that RT was the first-line treatment for most patients in their cohort. 27 When considering the underlying reasons for why rates of dual-modality therapy are trending downward, one possibility was a declining trend in positive margin rates over the study period. However, this was not the case given the stable rates of positive margins.…”

“…Previous work by Misono et al illustrated the decreasing use of both surgery and radiation to treat localized laryngeal SCC patients between 1995 and 2009, as well as a drastic increase in RT only treatment 26 . Additionally, a recent study by Friedman et al described the demographics of T1 and T2 glottic SCC using NCDB data from 2004–2016, and showed that RT was the first‐line treatment for most patients in their cohort 27 …”