Lymphovascular Invasion Predicts Survival in Laryngeal Cancer: A National Database Analysis

OBJECTIVE: Lymphovascular invasion (LVI) is routinely reported in laryngeal squamous cell carcinoma (LSCC), yet its independent prognostic significance and therapeutic implications remain uncertain. We evaluated the association between LVI and overall survival (OS) in a large cohort of surgically treated LSCC. METHODS: Adults with LSCC who underwent definitive surgical resection without distant metastases were included. Patients with preoperative radiotherapy, systemic therapy, or non-squamous histology were excluded. Multivariable Cox regression assessed the association between LVI and OS, adjusting for demographics, comorbidity, stage, subsite, surgical margins, facility type, and treatment modality. RESULTS: A total of 10,052 patients met inclusion criteria; 2037 (20.3%) had LVI. Mean follow-up was 70 ± 46 months. LVI was independently associated with worse OS (HR 1.22, 95% CI 1.13-1.32, p < 0.001), persisting in glottic (HR 1.30, p = 0.001) and supraglottic (HR 1.26, p < 0.001) tumors. Landmark analyses demonstrated temporal variation, with LVI remaining significantly associated with worse OS beyond 24 months of follow-up (HR 1.18, p = 0.001). Among patients with LVI, PORT and POCRT were associated with improved survival compared with surgery alone. CONCLUSION: LVI is an adverse prognostic factor associated with reduced survival in LSCC, with prognostic impact varying over time. Its integration into postoperative risk assessment may help inform adjuvant therapy selection and postoperative stratification.