| Objective:The purpose of this study was to investigate high risk factors,prognostic factors and the value of surgical treatment of patients with newly diagnosed laryngeal cancer with distant metastasis(DM),and to further explore the epidemiological characteristics of this particular population.Methods:The Surveillance,Epidemiology and End Result database(SEER)provided by the National Cancer Institute was used to analyze 421 patients of laryngeal cancer with DM(bone,brain,liver,lung)at the time of initial diagnosis from 2010 to 2015,a retrospective analysis of large population-based cases.The survival prognosis of patients with DM was performed by using Kaplan-Meier and Log-rank test.The prognostic factors and the effect of surgery were analyzed by using the Cox regression analysis and R-language data package.Classification was conducted according to age,gender,race,tumor site,T stage,N stage,and Fuhrman grade.High-risk factors for distant metastasis of laryngeal squamous cell carcinoma were studied by multivariate logistic regression.Kaplan-Meier and log-Rank tests were used to evaluate the differences in overall survival(OS)and cancer-specific survival(CSS)of each variable and subgroup.Variables with P<0.1 were screened for further analysis by multivariate regression Cox model to determine independent risk factors affecting OS and CSS.The competing risk model was constructed using the R language data package(R Foundation 3.5.1)to further explore the effect of risk factors on CSS in patients with DM.Finally,according to the results of Cox analysis,the Nomogram visual prediction model was constructed to predict the 1-,2-,and 3-year survival rates of patients for clinical reference.Results:During the period 2010-2015,the SEER database included a total of 421 patients with laryngeal squamous cell carcinoma with DM at the time of initial diagnosis.Lung was the most common distant metastatic site of laryngeal squamous cell carcinoma,and bone metastases had the worst prognosis of patient.Age ?60 years old,male,subglottic,T4,N1-3 were risk factors for distant metastasis.On Cox analysis,age,T stage,N stage,and bone metastasis were independent risk factors for OS and CSS(P<0.05).The risk of death in T4 patients was 1.69 times higher than that in T1 patients,and the risk of N3 patients dying from the tumor itself was 2.33 times that of patients with N0.Surgical treatment of primary and metastatic tumors can provide better survival for patients.Primary surgery was an independent protective factor for OS and CSS(P<0.001).The mortality risk of patient who hadn't undergo primary tumor surgery was 1.89 times that of surgical patients.Conclusion: 1.DM risk assessment should be conducted for patients with laryngeal squamous cell carcinoma.For patients with high risk of DM,such as age 60,male, subglottic type,T4,N1-3,etc.,attention should be paid to organ examinations such as lung,liver,bone and brain;2.Diagnostic age,T stage,N stage and bone metastasis are independent risk factors affecting the survival of patients with DM.Primary surgery is an independent protective factor affecting the survival of patients.Nomogram visualization model helps predict the1-,2-,and 3-year survival rates of patient with DM;3.Different metastatic sites have different effects on the survival outcome of patients,lung metastasis is relatively common with a better prognosis,the prognosis of patients with bone metastases is relatively poor;4.Active surgical treatment of primary tumors and metastases can lead to better survival for appropriate patients. |
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