Diverging incidence trends for larynx and tonsil cancer in low socioeconomic regions of the US

Laryngeal cancer incidence trends in the United States over 2000-2020: a population-based analysis

INTRODUCTION

Laryngeal cancers account for one-third of all head and neck cancers. We aimed to report the incidence trends of laryngeal cancer over 2000-2020 in the United States (US), by age, sex, race/ethnicity, and histological subtypes.

METHODS

Data from the Surveillance, Epidemiology, and End Results 22 database were used to identify patients with laryngeal cancer based on the International Classification of Diseases for Oncology, version 3. Age-standardized incidence rates (ASIRs) for laryngeal cancer, adjusted for reporting delays, were calculated. The Joinpoint Regression Program was then utilized to determine annual percent changes (APCs) and average annual percent changes (AAPCs) in the trends. The analysis excluded data from 2020 to prevent potential bias related to the COVID-19 pandemic.

RESULTS

A total of 104,991 cases of laryngeal cancer were identified in the US from 2000 to 2019. Squamous cell carcinoma was the predominant subtype, accounting for 94.53% of cases. Above 73.20% occurred among non-Hispanic whites, with the highest incidence observed among individuals aged 55-69 years (46.71%). The ASIRs were 5.98 and 1.25 per 100,000 population for men and women, respectively. Over 2000-2019, there was a significant reduction in ASIRs for laryngeal cancer in both sexes. Non-Hispanic black men exhibited the highest ASIR (9.13 per 100,000) and the largest decline in the ASIRs over 2000-2019 (AAPC: -3.26%).

CONCLUSIONS

Laryngeal cancer incidence rates showed a decline from 2000 to 2019, in addition to 2020, during the COVID-19 pandemic. Additional research is required to investigate risk factors and their influence on incidence rates of laryngeal cancer.

Mortality patterns of patients with tonsillar squamous cell carcinoma: a population-based study

Objective

Tonsillar squamous cell carcinoma (TSCC) and second primary malignancies (SPMs) are the most common causes of mortality in patients with primary TSCC. However, the competing data on TSCC-specific death (TSD) or SPM-related death in patients with TSCC have not been evaluated. This study aimed to analyze the mortality patterns and formulate prediction models of mortality risk caused by TSCC and SPMs.

Methods

Data on patients with a first diagnosis of TSCC were extracted as the training cohort from the 18 registries comprising the Surveillance, Epidemiology, and End Results (SEER) database. A competing risk approach of cumulation incidence function was used to estimate cumulative incidence curves. Fine and gray proportional sub-distributed hazard model analyses were performed to investigate the risk factors of TSD and SPMs. A nomogram was developed to predict the 5- and 10-year risk probabilities of death caused by TSCC and SPMs. Moreover, data from the 22 registries of the SEER database were also extracted to validate the nomograms.

Results

In the training cohort, we identified 14,530 patients with primary TSCC, with TSCC (46.84%) as the leading cause of death, followed by SPMs (26.86%) among all causes of death. In the proportion of SPMs, the lungs and bronchus (22.64%) were the most common sites for SPM-related deaths, followed by the larynx (9.99%), esophagus (8.46%), and Non-Melanoma skin (6.82%). Multivariate competing risk model showed that age, ethnicity, marital status, primary site, summary stage, radiotherapy, and surgery were independently associated with mortality caused by TSCC and SPMs. Such risk factors were selected to formulate prognostic nomograms. The nomograms showed preferable discrimination and calibration in both the training and validation cohorts.

Conclusion

Patients with primary TSCC have a high mortality risk of SPMs, and the competing risk nomogram has an ideal performance for predicting TSD and SPMs-related mortality. Routine follow-up care for TSCC survivors should be expanded to monitor SPMs.

Trends in Incidence and Mortality of Larynx Cancer in the US

Importance

Larynx cancer is associated with considerable morbidity for patients and has a high mortality rate. Historical analyses showed that the incidence of larynx cancer was decreasing but the mortality was not similarly improving.

Objective

To assess whether incidence and mortality trends in larynx cancer in the US have improved.

Design, Setting, and Participants

This cohort study used population-based data from the Surveillance, Epidemiology, and End Results Program database for patients older than 18 years who were diagnosed with laryngeal cancer between January 1, 1986, and December 31, 2018. Data were analyzed from May 1, 2021, to May 31, 2022.

Main Outcomes and Measures

The main outcomes were incidence and mortality of larynx cancer by sex, subsite, and patterns of surgical treatment.

Results

Among 40 850 US patients with larynx cancer diagnosed from 1986 to 2018 (80.4% male), the incidence of larynx cancer decreased 55% from 5.00 per 100 000 people (95% CI, 4.70-5.32 per 100 000 people) to 2.26 per 100 000 people (95% CI, 2.11-2.42 per 100 000 people). During the same period, mortality decreased only 43% from 1.59 per 100 000 people (95% CI, 1.53-1.64 per 100 000 people) to 0.89 per 100 000 people (95% CI, 0.86-0.92 per 100 000 people). This corresponds to a 25% relative increase in case-fatality rate. Examination by stage showed a decrease in the incidence of localized disease at diagnosis of 40% from 2.65 per 100 000 people (95% CI, 2.44-2.89 per 100 000 people) to 1.60 per 100 000 people (95% CI, 1.45-1.76 per 100 000 people) from 1986 to 2002 and of 45% from 2.15 per 100 000 people (95% CI, 1.98-2.34 per 100 000 people) to 1.19 per 100 000 people (95% CI, 1.08-1.31 per 100 000 people) from 2005 to 2018. Distribution of larynx cancer by subsite remained stable, with most cases affecting the glottis. The proportion of patients receiving surgery as their first course of treatment decreased regardless of stage at presentation.

Conclusions and Relevance

In this cohort study, between 1986 and 2018, the incidence of larynx cancer decreased in the US, primarily because of the decrease in the incidence of localized disease. Mortality did not decrease similarly, resulting in an increased case-fatality rate overall. Encouraging earlier referrals for cancer concern, focusing resources where larynx cancer rates remain highest, renewing attention to research on new biologic causes of different tumor biologic characteristics, and conducting trials to directly compare treatments may help reverse this trend.

Surveillance of the Incidence and Mortality of Oral and Pharyngeal, Esophageal, and Lung Cancer in Nevada: Potential Implications of the Nevada Indoor Clean Air Act

Reviews of national and state-specific cancer registries have revealed differences in rates of oral, esophageal, and lung cancer incidence and mortality that have implications for public health research and policy. Many significant associations between these types of cancers and major risk factors, such as cigarette usage, may be influenced by public health policy such as smoking restrictions and bans-including the Nevada Clean Indoor Air Act (NCIAA) of 2006 (and subsequent modification in 2011). Although evaluation of general and regional advances in public policy have been previously evaluated, no recent studies have focused specifically on the changes to the epidemiology of oral and pharyngeal, esophageal, and lung cancer incidence and mortality in Nevada. Methods: Cancer incidence and mortality rate data were obtained from the National Cancer Institute (NCI) Division of Cancer Control and Population Sciences (DCCPS) Surveillance, Epidemiology and End Results (SEER) program. Most recently available rate changes in cancer incidence and mortality for Nevada included the years 2012-2016 and are age-adjusted to the year 2000 standard US population. This analysis revealed that the overall rates of incidence and mortality from these types of cancer in Nevada differs from that observed in the overall US population. For example, although the incidence rate of oral cancer is decreasing in the US overall (0.9%), it is stable in Nevada (0.0%). However, the incidence and mortality rates from esophageal cancer are also decreasing in the US (-1.1%, -1.2%, respectively), and are declining more rapidly in Nevada (-1.5%, -1.9%, respectively). Similarly, the incidence and mortality rates from lung are cancer are declining in the US (-2.5%, -2.4%, respectively) and are also declining more rapidly in Nevada (-3.2%, -3.1%, respectively). Analysis of previous epidemiologic data from Nevada (1999-2003) revealed the highest annual percent change (APC) in oral cancer incidence in the US was observed in Nevada (+4.6%), which corresponded with the highest APC in oral cancer mortality (+4.6%). Subsequent studies regarding reduced rates of cigarette use due to smoking restrictions and bans have suggested that follow up studies may reveal changes in the incidence and mortality rates of oral and other related cancers. This study analysis revealed that oral cancer incidence rates are no longer increasing in Nevada and that mortality rates have started to decline, although not as rapidly as the overall national rates. However, rapid decreases in both the incidence and mortality from esophageal and lung cancer were observed in Nevada, which strongly suggest the corresponding changes in oral cancer may be part of a larger epidemiologic shift resulting from improved public health policies that include indoor smoking restrictions and bans.

The Impact of Socioeconomic Status on Hospital Accessibility in Otorhinolaryngological Disease in Korea

This study aimed to investigate the impact of socioeconomic status (SES) on otorhinolaryngology disease severity status diagnosed at the first hospital visit. We conducted a retrospective study over 20 years (2000-2019). Otorhinolaryngological diseases included chronic rhinosinusitis (CRS), sensorineural hearing loss (SNHL), oral ulcer, and malignant neoplasms. A logistic regression model was employed to assess the effect of SES on the severity of each disease at the first hospital visit. The severity of CRS increased in patients with lower SES (P = .028). The severities of SNHL (P = .032) and oral ulcer (P < .001) also associated with SES. In contrast, between the low- and high-SES groups observed no differences in cancer stage (P = .845). Patients with SNHL, oral ulcer, and CRS had a more severe disease status in the low-SES group than in the high-SES group at the first hospital visit. Efforts to increase hospital accessibility for low-SES otorhinolaryngological patients should be made.

Convolutional Neural Network Classifies Pathological Voice Change in Laryngeal Cancer with High Accuracy

Voice changes may be the earliest signs in laryngeal cancer. We investigated whether automated voice signal analysis can be used to distinguish patients with laryngeal cancer from healthy subjects. We extracted features using the software package for speech analysis in phonetics (PRAAT) and calculated the Mel-frequency cepstral coefficients (MFCCs) from voice samples of a vowel sound of /a:/. The proposed method was tested with six algorithms: support vector machine (SVM), extreme gradient boosting (XGBoost), light gradient boosted machine (LGBM), artificial neural network (ANN), one-dimensional convolutional neural network (1D-CNN) and two-dimensional convolutional neural network (2D-CNN). Their performances were evaluated in terms of accuracy, sensitivity, and specificity. The result was compared with human performance. A total of four volunteers, two of whom were trained laryngologists, rated the same files. The 1D-CNN showed the highest accuracy of 85% and sensitivity and sensitivity and specificity levels of 78% and 93%. The two laryngologists achieved accuracy of 69.9% but sensitivity levels of 44%. Automated analysis of voice signals could differentiate subjects with laryngeal cancer from those of healthy subjects with higher diagnostic properties than those performed by the four volunteers.