Long-term Survival Analysis After Total Laryngectomy For Locally Advanced Laryngeal Carcinoma Patients

Purpose: To retrospectively evaluate long-term survival trends after total laryngectomy(TL)for locally advanced laryngeal carcinoma(LC)based on comprehensive survival analysis.Methods: In this study,from the Surveillance,Epidemiology,and End Results(SEER)database,a total of 2094 locally advanced LC patients diagnosed between 1992 and 2011and underwent TL were included.Besides the overall survival(OS)and cancer-specific survival(CSS)by using Kaplan-Meier(K-M)curves,the 3-year conditional survival(3CS)analysis was also applied to evaluate the survival evolution in these patients.Additionally,time-dependent multivariate competing-risk models(CRM)were constructed to assess the persistent sub-distribution hazard of prognostic factors.Finally,a nomogram was developed to predict conditional cancer-specific survival.Results: The curves of overall hazard and cancer-specific hazard both reached the apex rapidly within the first year,then decreased after that.Generally,the 3CS steadily increased from within 5 years after TL.According to the K-M curves,age,gender,marital status,pathological grade,positive lymph node ratio(p LNR),and N stage significantly influence both OS and CSS.In the stratified 3CS analysis,the increments in patients with adverse characteristics were more pronounced.In the time-dependent multivariate CRM,age and p LNR constantly impacted the cancer-specific outcome.4 years after TL,the probability of surviving the next year exceeded 90%.According to the CRM,a nomogram was constructed to estimate CSS probability conditional upon 3 years for these patients having survived 1,2,and 3 years.Conclusion: After TL,most patients had substantially improved survival rates.Patients diagnosed with an older age and higher p LNR should receive more effective follow-up or adjuvant therapy.The proposed nomogram can provide significant evidence for prognostic prediction and treatment decision.