Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy
Background: To assess the presence of adverse pathological features at the time of salvage total laryngectomy (TL) associated with oncologic outcome. Methods: Ninety patients with persistent/locally recurrent disease and who subsequently underwent salvage TL after definitive treatment by radiation a...
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doaj-e500f178a58e4f18aaa993b7ba2c38b32021-01-07T00:02:03ZengMDPI AGInternational Journal of Environmental Research and Public Health1661-78271660-46012021-01-011837137110.3390/ijerph18020371Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total LaryngectomyMing-Hsien Tsai0Hui-Ching Chuang1Yu-Tsai Lin2Tai-Lin Huang3Fu-Min Fang4Hui Lu5Chih-Yen Chien6Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanKaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, TaiwanKaohsiung Chang Gung Head and Neck Oncology Group, Cancer Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanBackground: To assess the presence of adverse pathological features at the time of salvage total laryngectomy (TL) associated with oncologic outcome. Methods: Ninety patients with persistent/locally recurrent disease and who subsequently underwent salvage TL after definitive treatment by radiation alone (RTO) or concurrent chemo-radiation (CCRT) from 2009 to 2018 were retrospectively enrolled. Kaplan–Meier methods were used to estimate overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Results: Lymphovascular invasion (LVI), perineural invasion, positive margin, and stage IV disease were associated with worse survival in the univariate analysis. In the multivariate analysis, the presence of LVI and positive margin were both independent negative predictors in OS (LVI: adjusted hazard ratio (aHR) = 2.537, 95% CI: 1.163–5.532, <i>p</i> = 0.019; positive margin: aHR = 5.68, 95% CI: 1.996–16.166, <i>p</i> = 0.001), DSS (LVI: aHR = 2.975, 95% CI: 1.228–7.206, <i>p</i> = 0.016); positive margin: aHR = 11.338, 95% CI: 2.438–52.733, <i>p</i> = 0.002), and DFS (LVI: aHR 2.705, 95% CI: 1.257–5.821, <i>p</i> = 0.011; positive margin (aHR = 6.632, 95% CI: 2.047–21.487, <i>p</i> = 0.002). Conclusions: The presence of LVI and positive margin were both associated with poor OS, DSS, and DFS among patients who underwent salvage TL after failure of RTO/CCRT. The role of adjuvant therapy for high-risk patients after salvage TL to improve the chance of survival requires more investigation in the future.https://www.mdpi.com/1660-4601/18/2/371lymphovascular invasionsurgical marginprognosislaryngeal cancerhypopharyngeal cancer |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ming-Hsien Tsai Hui-Ching Chuang Yu-Tsai Lin Tai-Lin Huang Fu-Min Fang Hui Lu Chih-Yen Chien |
spellingShingle |
Ming-Hsien Tsai Hui-Ching Chuang Yu-Tsai Lin Tai-Lin Huang Fu-Min Fang Hui Lu Chih-Yen Chien Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy International Journal of Environmental Research and Public Health lymphovascular invasion surgical margin prognosis laryngeal cancer hypopharyngeal cancer |
author_facet |
Ming-Hsien Tsai Hui-Ching Chuang Yu-Tsai Lin Tai-Lin Huang Fu-Min Fang Hui Lu Chih-Yen Chien |
author_sort |
Ming-Hsien Tsai |
title |
Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy |
title_short |
Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy |
title_full |
Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy |
title_fullStr |
Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy |
title_full_unstemmed |
Survival Outcomes and Predictors for Patients who Failed Chemoradiotherapy/Radiotherapy and Underwent Salvage Total Laryngectomy |
title_sort |
survival outcomes and predictors for patients who failed chemoradiotherapy/radiotherapy and underwent salvage total laryngectomy |
publisher |
MDPI AG |
series |
International Journal of Environmental Research and Public Health |
issn |
1661-7827 1660-4601 |
publishDate |
2021-01-01 |
description |
Background: To assess the presence of adverse pathological features at the time of salvage total laryngectomy (TL) associated with oncologic outcome. Methods: Ninety patients with persistent/locally recurrent disease and who subsequently underwent salvage TL after definitive treatment by radiation alone (RTO) or concurrent chemo-radiation (CCRT) from 2009 to 2018 were retrospectively enrolled. Kaplan–Meier methods were used to estimate overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS). Results: Lymphovascular invasion (LVI), perineural invasion, positive margin, and stage IV disease were associated with worse survival in the univariate analysis. In the multivariate analysis, the presence of LVI and positive margin were both independent negative predictors in OS (LVI: adjusted hazard ratio (aHR) = 2.537, 95% CI: 1.163–5.532, <i>p</i> = 0.019; positive margin: aHR = 5.68, 95% CI: 1.996–16.166, <i>p</i> = 0.001), DSS (LVI: aHR = 2.975, 95% CI: 1.228–7.206, <i>p</i> = 0.016); positive margin: aHR = 11.338, 95% CI: 2.438–52.733, <i>p</i> = 0.002), and DFS (LVI: aHR 2.705, 95% CI: 1.257–5.821, <i>p</i> = 0.011; positive margin (aHR = 6.632, 95% CI: 2.047–21.487, <i>p</i> = 0.002). Conclusions: The presence of LVI and positive margin were both associated with poor OS, DSS, and DFS among patients who underwent salvage TL after failure of RTO/CCRT. The role of adjuvant therapy for high-risk patients after salvage TL to improve the chance of survival requires more investigation in the future. |
topic |
lymphovascular invasion surgical margin prognosis laryngeal cancer hypopharyngeal cancer |
url |
https://www.mdpi.com/1660-4601/18/2/371 |
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