Refusal of surgery in patients with laryngeal or hypopharyngeal squamous cell carcinoma

BACKGROUND: Patients with laryngeal and hypopharyngeal cancers may refuse recommended surgery owing to concerns about voice loss. OBJECTIVES: To investigate the factors associated with surgery refusal and the survival outcomes of patients who refused surgery. PATIENTS AND METHODS: We obtained data from 24,340 surgery and 1500 refusal cases using the Surveillance, Epidemiology, and End Results database. Overall survival (OS) rates were estimated using the Kaplan-Meier method. Odds ratios for surgery refusal and hazard ratios (HRs) for death were calculated using logistic regression and Cox proportional hazard models. RESULTS: < 0.001). Within the refusal group, patients who refused both surgery and radiation therapy (RT) had a five-year survival rate of 8.9%, whereas those who refused surgery but received RT showed a five-year OS rate of 36.3%. Administration of RT and chemotherapy were independent prognostic factors for OS (HR 0.41 (95%CI 0.35-0.48) and 0.80 (95%CI 0.69-0.91), respectively). CONCLUSIONS: Although non-surgical treatment remains an alternative option, surgery refusal is associated with poor prognosis.