Association of Facility Case Volume and Patient Travel Distance With Survival in Laryngeal Squamous Cell Carcinoma

BACKGROUND: Treatment of laryngeal squamous cell carcinoma (SCC) requires specialized expertise. While high-volume facilities demonstrate superior outcomes, the relationship between facility volume and travel distance on survival remains poorly understood. METHODS: Retrospective cohort study using the National Cancer Database (2004-2022) of adults with laryngeal SCC receiving definitive treatment. Risk-adjusted restricted cubic splines characterized non-linear survival relationships, guiding development of multivariable Cox-proportional hazards regression models. RESULTS: Among 106 700 patients, an inflection point was identified at 10 cases/year. Below this threshold, volume had no effect (HR 1.00 [95% CI: 0.97-1.03]); above it, each doubling was associated with an 11% mortality reduction (HR 0.89 [0.84-0.94]). Travel distance showed a paradoxical protective effect (HR 0.97 [0.96-0.99]), but only in advanced-stage disease (HR 0.96 [0.94-0.97]), with no effect in early-stage disease. CONCLUSIONS: A 10-case/year threshold exists for laryngeal SCC care. Early-stage disease can be treated at facilities meeting this, while advanced-stage disease may warrant referral to higher-volume centers.