Prognostic impact of stage, chronic obstructive pulmonary disease and second primary malignancies in laryngeal cancer: a single-center retrospective cohort study

Aim: Tumor stage and comorbid conditions are well-established prognostic factors in laryngeal cancer (LC); however, their combined impact on survival has not been comprehensively evaluated in real-world settings. This study aimed to assess the effects of tumor stage, comorbidities, and second primary malignancies (SPMs) on long-term survival in patients with LC. Material and Methods: We retrospectively analyzed data from 130 patients with histologically confirmed laryngeal squamous cell carcinoma who were treated and followed at our institution between 2010 and 2023. Survival outcomes were assessed using the Kaplan--Meier method and Cox proportional hazards regression. The prognostic impact of comorbidities, COPD, and SPMs was specifically evaluated. Results: The mean overall survival (OS) for the entire cohort was 87.1 months (95% CI: 72.2--101.9). Patients with metastatic disease had significantly shorter OS (mean: 10.2 months; p < 0.001), and those with at least one comorbidity had a reduced OS of 70.2 months (p = 0.004). Metastatic disease was associated with a 4.9-fold increased risk of mortality (HR = 4.92; p < 0.001). SPMs occurred in 15 patients (11.5%), and three patients (2.3%) died due to SPMs. In multivariate analysis, both SPMs (HR = 2.37; 95% CI: 1.48--3.79; p = 0.002) and COPD (HR = 1.88; 95% CI: 1.22--2.90; p = 0.008) were identified as independent predictors of worse survival. Conclusion: Tumor stage, comorbidities, and second primary malignancies independently and synergistically impact survival outcomes in patients with laryngeal cancer. These findings underscore the importance of a multidisciplinary care model that integrates oncologic treatment with comorbidity management and vigilant follow-up.