Laryngectomy and Overall Survival in cT4b Laryngeal Squamous Cell Carcinoma

ABSTRACT Objective To compare surgical and non‐surgical definitive treatment in cT4b laryngeal squamous cell carcinoma (LSCC). Methods The 2004–2019 National Cancer Database (NCDB) was queried for patients with cT4b LSCC ( N = 871). Patients undergoing definitive treatment with (1) laryngectomy + radiotherapy (RT)/chemoradiotherapy (CRT), RT alone, or (3) CRT were included in Kaplan–Meier and Cox survival analyses. Results Of 207 patients undergoing definitive treatment, 41 (19.8%) underwent laryngectomy + RT/CRT therapy and 166 (80.2%) underwent primary RT/CRT. Among patients undergoing laryngectomy + RT/CRT, 15 (39.5%) remained pT4b and 9 (22.1%) had positive margins. There were no documented mortalities within 90 days of laryngectomy. Nodal (79.3% vs. 79.9%, p = 0.038) and distant (30.7% vs. 0.0%, p < 0.001) metastasis were associated with decreased odds of undergoing definitive treatment. Five‐year overall survival (OS) of laryngectomy + RT/CRT and definitive RT/CRT was 39% and 22%, respectively ( p = 0.005). Laryngectomy + RT/CRT (aHR: 0.54, 95% CI: 0.35–0.84) was associated with higher OS than definitive RT/CRT ( p = 0.006). A separate cohort of 2807 patients with cT4a tumors was created; cT4a and cT4b (HR: 1.34, 95% CI: 0.89–2.02, p = 0.165) tumors had similar OS. Conclusions A minority of patients with cT4b LSCC underwent definitive treatment. Laryngectomy + RT/CRT therapy was safe and associated with higher OS than definitive RT/CRT, despite the high rate of PSM. In the absence of clinical trial data, appropriately selected patients with cT4b LSCC may benefit from laryngectomy. Level of Evidence 3.