Effect of Surgery on Prognosis of Laryngeal Cancer Patients and Its Influencing Factors: A Retrospective Study Based on Seer Database

Background: Currently, the primary treatment modality for laryngeal cancer (LC) is surgery. However, there is almost no evidence on the effectiveness of surgical resection in the prognosis of laryngeal cancer patients.. Furthermore, the prognostic factors influencing outcomes in patients undergoing surgery for laryngeal cancer remain largely unexplored and poorly understood. Methods: In this study, 59,873 patients with laryngeal tumors from 2000 to 2021 in the Surveillance, Epidemiology, and End Results (SEER) database were analyzed retrospectively. First, we applied propensity score matching (PSM) to construct a balanced cohort with and without surgery by 1:1 pairing with 0.2 standard deviation. After that, Kaplan-Meier analysis and multivariate Cox regression analysis were conducted to assess the therapeutic effect of surgery on patients and we used overall survival (OS) and laryngeal cancer-specific survival (LCSS) to measure it. The two groups were compared by constructing Fine-Gray competitive risk model. The nomogram prediction model of OS and LCSS in patients undergoing LC surgery was established by R software. Finally, the feasibility of the model was verified by calibration curve and consistency index (C-index). Results: A total of 12,283 eligible patients were screened out, and 6,446 (52.4%) patients among it have received surgery. 7393 patients were successfully matched by PSM, and there was roughly a balance between the groups. In the matched data set, multivariate Cox analysis shows that surgery can reduce the risk of OS by 35.9%(HR=0.641, 95%CI 0.606 to 0.677) and the risk of LCSS by 41.5%(HR=0.585, 95%CI 0.533 to 0.641). The competitive risk model also shows that surgery can reduce the risk of patients. In addition, the nomogram model indicates that the surgical patients with radiotherapy can benefit more from surgery, while the patients with chemotherapy may be negatively affected.Finally, the 1-year, 5-year and 10-year survival rates of patients are intuitively visualized. Conclusion: This study provides evidence that surgery can improve the prognosis of patients with laryngeal cancer, especially the subgroup of patients with glottic tumors and radiotherapy.