Incidence and survival of laryngeal cancer in Denmark: a nation-wide study from 1980 to 2014

Prognostic effects of different treatment modalities for hypopharyngeal squamous cell carcinoma: Experience of two tertiary hospitals in Southwestern China

Background

The prognostic effects of different treatment modalities on patients with hypopharyngeal squamous cell carcinoma (HPSCC) remain unclear.

Methods

HPSCC patients diagnosed and treated at either West China Hospital or Sichuan Cancer Hospital between January 1, 2009, and December 31, 2019, were enrolled in this retrospective, real-world study. Survival rates were presented using Kaplan-Meier curves and compared using log-rank tests. Univariable and multivariable Cox proportional hazards regression models were used to identify the predictors of overall survival (OS). Subgroup analyses were conducted for patients with advanced-stage HPSCC (stages III and IV and category T4).

Results

A total of 527 patients with HPSCC were included. Patients receiving SRC (surgery, radiotherapy [RT], and chemotherapy) showed the best OS (p < 0.0001). In comparison with RT alone, both surgery alone (all cases: hazard ratio [HR] = 0.39, p = 0.0018; stage IV cases: HR = 0.38, p = 0.0085) and surgery-based multimodality treatment (SBMT; all cases: HR = 0.27, p < 0.0001; stage IV cases: HR = 0.30, p = 0.00025) showed prognostic benefits, while SBMT also showed survival priority over chemoradiotherapy (CRT; all cases: HR = 0.52, p < 0.0001; stage IV cases: HR = 0.59, p = 0.0033). Moreover, patients who underwent surgery alone had comparable OS to those who underwent SBMT (all patients: p = 0.13; stage IV cases: p = 0.34), while CRT yielded similar prognostic outcomes as RT alone (all patients: p = 0.054; stage IV cases: p = 0.11).

Conclusions

Surgery alone was comparable to SBMT and superior to RT/CRT in terms of OS in patients with HPSCC. We suggest that surgery should be encouraged for the treatment of HPSCC, even in patients with advanced-stage disease.

Survival in oral and pharyngeal cancers is catching up with laryngeal cancer in the NORDIC countries through a half century

BACKGROUND

Cancers of the head and neck (HN) are heterogeneous tumors with incidence rates varying globally. In Northern Europe oral and oropharyngeal cancers are the most common individual types. Survival for HN varies by individual tumor type but for most of them survival trends are not well known over extended periods of time.

METHODS

Data for a retrospective survival study were obtained for Danish, Finnish, Norwegian, and Swedish patients from the NORDCAN database from 1971 to 2020. Relative 1- and 5-year survival rates and 5/1-year conditional survival for years 2-5 were calculated.

RESULTS

Both 1- and 5-year survival improved for all HN cancers but only marginally for laryngeal cancer. For the other cancers a 50-year increase in 5-year survival was about 30% units for nasopharyngeal and oropharyngeal cancers, 20% units for oral cancer and somewhat less for hypopharyngeal cancer.

CONCLUSIONS

5-year survival reached about 65% for all HN cancers, except for hypopharyngeal cancer (30%). Human papilloma virus infection is becoming a dominant risk factor for the rapidly increasing oropharyngeal cancer, the prevention of which needs to emphasize oral sex as a route of infection.

Survival in an era of organ preservation: an update on laryngeal cancer in Ireland

BACKGROUND

Laryngeal cancer epidemiology has changed in recent years, with falling incidence observed internationally. Organ preservation therapies have revolutionised management, though some patients may be unsuitable and survival was noted to fall in the 2000s. This study examines trends in laryngeal cancer in Ireland.

METHODS

A retrospective cohort study of National Cancer Registry of Ireland data from 1994 to 2014.

RESULTS

From a cohort of 2651, glottic disease was most common (62%, n = 1646). Incidence rose to 3.43 cases/100,000/year for 2010-2014. 5-year disease-specific survival (DSS) was 60.6% and did not change significantly over time. Overall survival (OS) for T3 disease managed with primary radiotherapy was similar to primary surgery (HR 0.98, p = 0.9). DSS for T3 disease improved with primary radiotherapy (HR 0.72, p = 0.045).

CONCLUSION

Incidence of laryngeal cancer in Ireland rose despite international trends, while survival changed little. Radiotherapy improves DSS for T3 disease but does not improve OS, possibly secondary to poor organ function post-radiotherapy.

Epidemiology of laryngeal cancer in Brazil: Historical data from 2000 to 2019

INTRODUCTION

To determine the incidence, morbidity, and mortality rate of laryngeal cancer in two decades and its epidemiological, clinical, and histological characteristics by sex in Brazil.

METHODS

This ecological study used three reliable sources of secondary data: population- and hospital-based cancer registries and the national mortality database. All data available from 2000 to 2019 were considered.

RESULTS

The incidence of male laryngeal cancer decreased from 9.20 to 4.95 per 100,000 from 2000 to 2018, while mortality slightly decreased from 3.37 to 3.30 per 100,000 from 2000 to 2019. In the same period, the female incidence decreased from 1.26 to 0.48 per 100,000; however, mortality slightly increased from 0.34 to 0.36 per 100,000. Of 221,566 individuals with head and neck cancer, 27 % presented laryngeal cancer. The median age was 61 years (54-69), and most individuals were male (86.6 %), smokers (66.2 %), diagnosed with locally advanced cancer (66.7 %), and squamous cell carcinoma as the main histological type (93.2 %). Male tended to be older (p < 0.001), white (p < 0.001), smokers (p < 0.001), and present late treatment initiation (p < 0.001) and early death (p < 0.001) compared with female.

CONCLUSION

The male laryngeal cancer affected mainly at productive age but with a decreased incidence, probably due to a reduction in smoking habit. However, mortality did not change, which may be explained by the late diagnosis and lack of access to radiotherapy.

Increased incidence of rare cancers and varied age distributions by cancer group: A population-based cancer registry study in Hiroshima Prefecture, Japan

BACKGROUND

Epidemiological characteristics of many types of rare cancers are limited especially in Asia. Therefore, this study aimed to describe the burden and changing time trends of rare cancers in Hiroshima, Japan.

METHODS

The internationally agreed RARECAREnet list of rare cancers was used to identify patients diagnosed with cancers from 2005 to 2015 who were registered in the Hiroshima Prefecture Cancer Registry. Quality indicators specific to rare cancers were assessed by cancer grouping. Crude incidence rates (IRs) and age-standardized rates (ASRs) were calculated for 216 single cancers (rare and common) included in the list. A joinpoint regression was used to analyze age distribution and time trends in the ASRs for 12 internationally agreed rare cancer families. Quality indicators, ASRs, and IRs in Japan were identified to examine IR differences and the effects on data accuracy.

RESULTS

The 231,328 cases were used to calculate the IRs of each cancer. Epithelial tumors in rare families increased with age, but nonepithelial tumors occurred at any age. The proportion of rare cancer families to total cancers was stable. The time trend for families of head and neck cancers (annual percent change and 95 % confidence interval: 2.4 %; 1.2-3.7 %), neuroendocrine tumors (6.6 %; 5.1-8.1 %), and hematological cancers (4.3 %; 3.2-5.5 %) markedly increased.

CONCLUSION

The ASRs of several rare cancers increased because of increased knowledge of these diseases, improved diagnostic techniques, and aggressive diagnoses.

Global trend and risk factors of the disease burden for pharynx and larynx cancers between 1990 and 2019: a systematic analysis of the global burden of disease study 2019

BACKGROUND

Pharynx and larynx cancers (PLCs) are the top killer cancers in head and neck and significantly affect the quality of life of patients. A detailed study examining the disease burden and risk factors of PLCs is lacking.

METHODS

Data on mortality and disability-adjusted life-years (DALYs) were extracted from the Global Burden of Disease Study 2019. The estimated annual percentage change (EAPC) of the age-standardized mortality rate was calculated using a generalized linear model with a Gaussian distribution. Mortality and DALYs were stratified according to the sociodemographic index (SDI), age, gender, and risk factors. The association between the SDI and mortality rate was measured using Spearman's correlation.

RESULTS

Between 1990 and 2019, the total number of deaths due to PLCs increased by 60.7% (95% confidence intervals: 39.32 to 66.8), from 192.38 thousand in 1990 to 309.16 thousand in 2019, and the total DALYs due to PLCs increased by 49.41% (95% confidence intervals: 30.15 to 53.27), from 5.91 million in 1990 to 8.83 million in 2019. The age-standardized mortality rate declined for larynx cancer (from 2.19 in 1990 to 1.49 in 2019) and nasopharynx cancer (1.26 to 0.86) but increased slightly for other pharynx cancer (1.25 to 1.37). The death number of PLCs was significantly higher in men aged 50 to 70 years, which accounts for 46.05% and 43.83% of the total deaths in 1990 and 2019, respectively. Low and low-middle countries had the greatest age-standardized mortality rate for larynx and other pharynx cancer, while low-middle and middle countries dominated for nasopharynx cancer. The leading risk factors for PLCs were smoking and alcohol use, which account for 37.92% and 58.84% in total DALYs rate of PLCs, and the influence of risk factors was significant in men.

CONCLUSION

The total number of deaths and DALYs due to PLCs increased from 1990 to 2019. Countries with relatively low SDI and middle-aged and older men had the greatest burden of PLCs. Building better health care systems in relatively low SDI countries and improving strategies of smoking and alcohol control should be a priority in health policy.

Association between postoperative radiotherapy for young-onset head and neck cancer and long-term risk of second primary malignancy: a population-based study

Background

Second primary malignancy (SPM) represents the leading long-term cause of death among patients with index head and neck squamous cell carcinoma (HNSCC). We aimed to quantify the association between postoperative radiotherapy (PORT) and the risk of SPM development for index HNSCC among adolescent and young patients, who are particularly vulnerable to radiation-associated impacts due to their increased tissue susceptibilities and longer life expectancies.

Methods

This study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database to collect the data of 5 year survivors of index young-onset HNSCC from 1975 to 2011. The outcome of interest was SPM, a new, metachronous malignancy after the index HNSCC. Standardized incidence ratios (SIRs) and excess absolute risks (EARs) were used to quantify the PORT-associated risks externally, and relative risks (RRs) were estimated by the multivariate Poisson regression analysis to quantify the PORT-associated risks internally.

Results

Of the included 2771 5 year survivors with index young-onset HNSCCs, the receipt of PORT (37.6%) was associated with higher risk of SPMs (RR, 1.23; 95% CI 1.07 to 1.43). PORT-associated risks were elevated for the majority of sites, including head and neck (RR, 1.19; 95% CI 0.95 to 1.50) and lung (RR, 1.67; 95% CI 1.18 to 2.34). With regarding to the subsites of head and neck, RRs were above unity in oral cavity squamous cell carcinoma (SCC) (RR, 1.68; 95% CI 1.39 to 2.03) and laryngeal SCC (RR, 1.02; 95% CI 0.73 to 1.43). A relatively greater RR was observed for patients younger than 35 years (RR, 1.44, 95% CI 0.37 to 5.57) and those diagnosed with localized diseases (RR, 1.16, 95% CI 0.9 to 1.5). PORT-associated risks were increased remarkably after 15 years of follow-up (RR, 1.24; 95% CI 0.97 to 1.58).

Conclusions

An association was discovered between PORT treatment and increased long-term risk of SPM among patients with index young-onset HNSCC. The findings suggest long-term follow-up surveillance for these patients, particularly those with oral cavity SCC or laryngeal SCC.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12967-022-03544-y.

Locoregional recurrence prediction in head and neck cancer based on multi-modality and multi-view feature expansion

Objective. Locoregional recurrence (LRR) is one of the leading causes of treatment failure in head and neck (H&N) cancer. Accurately predicting LRR after radiotherapy is essential to achieving better treatment outcomes for patients with H&N cancer through developing personalized treatment strategies. We aim to develop an end-to-end multi-modality and multi-view feature extension method (MMFE) to predict LRR in H&N cancer. Approach. Deep learning (DL) has been widely used for building prediction models and has achieved great success. Nevertheless, 2D-based DL models inherently fail to utilize the contextual information from adjacent slices, while complicated 3D models have a substantially larger number of parameters, which require more training samples, memory and computing resources. In the proposed MMFE scheme, through the multi-view feature expansion and projection dimension reduction operations, we are able to reduce the model complexity while preserving volumetric information. Additionally, we designed a multi-modality convolutional neural network that can be trained in an end-to-end manner and can jointly optimize the use of deep features of CT, PET and clinical data to improve the model’s prediction ability. Main results. The dataset included 206 eligible patients, of which, 49 had LRR while 157 did not. The proposed MMFE method obtained a higher AUC value than the other four methods. The best prediction result was achieved when using all three modalities, which yielded an AUC value of 0.81. Significance. Comparison experiments demonstrated the superior performance of the MMFE as compared to other 2D/3D-DL-based methods. By combining CT, PET and clinical features, the MMFE could potentially identify H&N cancer patients at high risk for LRR such that personalized treatment strategy can be developed accordingly.

Incidence and survival in laryngeal and lung cancers in Finland and Sweden through a half century

Global survival studies have shown favorable development in most cancers but few studies have considered laryngeal cancer, particularly over extended periods or in populations for which medical care is essentially free of charge. We analyzed laryngeal and lung cancer incidence and survival in Finland (FI) and Sweden (SE) over a 50-year period (1970–2019) using data and statistical tools from the Nordcan database. Laryngeal cancer reached an incidence maximum in FI men in 1965, which in SE men occurred over 10 years later and peaking at 42% of the FI maximum. The FI incidence halved in 20 years while halving of the SE rate took almost twice as long. At maximum the male rate exceeded the female rate 20 times in FI and 10 times in SE. Incidence rates for lung cancer were approximately 10 times higher than those for laryngeal cancer, and they peaked 5 to 10 years after laryngeal cancer in both countries. The female lung cancer rates increased through the follow-up time but laryngeal cancer rates were relatively stable. Relative 1-year survival data for laryngeal cancer remained at around 85% through 50 years, and 5-year survival lagged constantly around 65%. For lung cancer 1-year survival improved and reached about 50% by 2019. Even 5-year survival improved reaching 20 to 30%, except for FI men. Incidence rates for laryngeal and lung cancers have drastically decreased in FI and SE men parallel to reduced smoking prevalence. In females, rates have clearly increased in lung but not in FI laryngeal cancer. This finding warrants further investigations into possible contributing factors, other than smoking. Survival in laryngeal cancer has not improved compared to the positive development in lung cancer. Historical smoking prevalence was unrelated of survival trends. As long-term survival in these cancers remains discouraging, the most efficient way to fight them is to target the main cause and promote non-smoking.

Factors Associated With a Prolonged Diagnosis-to-Treatment Interval in Laryngeal Squamous Cell Carcinoma

OBJECTIVE

Evaluate factors associated with treatment delays and their effect on survival in laryngeal squamous cell carcinoma.

STUDY DESIGN

Retrospective cohort study.

SETTING

National Cancer Database.

METHODS

Patients receiving primary radiation or surgery for laryngeal squamous cell carcinoma were included from 2004 to 2017. The primary outcomes were the diagnosis-to-treatment interval (DTI) and 5-year survival. Variables of prolonged DTI (>30 days) were assessed via logistic regression models. Survival was then assessed through Cox proportional hazards models. Candidate variables for both outcomes included age, sex, race, ethnicity, distance to treatment facility, insurance coverage, treatment facility type, TNM T stage, nodal status, and DTI (in models estimating survival).

RESULTS

An overall 136,203 patients with laryngeal cancer were identified, from which 51,747 remained after exclusions were applied: 18,499 received primary surgery and 33,248 received primary radiation. Being a member of a racial or ethnic minority, advanced age, female sex, ≥30 miles from treatment facility, lack of insurance, treatment at an academic cancer center, and primary radiation were associated with a prolonged DTI. However, in spite of a faster DTI, treatment at a community cancer center was independently associated with higher mortality (hazard ratio, 1.2; P < .0001).

CONCLUSIONS

Despite being associated with prolonged DTI, receiving treatment at a high-volume academic facility was associated with significantly improved survival. Our results indicate that improved referral pathways or outreach may help improve survival in laryngeal cancer, especially in high-risk populations.

Factors favoring neck metastasis in patients underwent laryngectomy for laryngeal cancer

Background

One third of all head and neck cancers are caused by laryngeal cancer. However, the incidence and prevalence rates have decreased over the past 3 decades. Neck metastasis from cancer larynx is important to be addressed as its presence greatly reduces the probability of survival. However, quality of life should be taken into consideration. Hence, it was important to analyze factors related to neck metastasis from primary laryngeal cancer to detect any change of tumor behavior with time.

Results

One hundred thirty-eight patients underwent concomitant neck dissection with laryngectomy (total or partial). Supraglottic tumors had the greatest share in the neck metastasis with a count of 11 (of 26 neck metastasis), representing 42% and a total value of 11 (of 30 total supraglottic cancer) representing a tendency of spread in 37% of the total case number. Tumor midline crossing was present in 77% cases (20 of 26) with positive nodes, representing a P value 0.05.

Conclusion

This study investigated different factors related to lymph node metastasis from primary laryngeal tumor. The most important factors were the site of the tumor and its relation to the midline.

Temporal trends in incidence and mortality rates of laryngeal cancer at the global, regional and national levels, 1990-2017

OBJECTIVES

Laryngeal cancer is the most prevalent entity of head and neck cancer. Knowing the trends of incidence and mortality of laryngeal cancer is important for the reduction in related disease burden.

DESIGN

Population-based observational study.

MAIN OUTCOMES AND MEASURES

The incidence and mortality data of laryngeal cancer were retrieved from the Global Burden of Disease study 2017 online database. The estimated average percentage change was used to quantify the trends of laryngeal cancer incidence and mortality at the global, regional and national levels.

RESULTS

Globally, the numbers of incident cases and deaths due to laryngeal cancer increased 58.7% and 33.9%, respectively, from 1990 to 2017. However, the overall age-standardised incidence rate (ASIR) and age-standardised mortality rate decreased by 0.99% (95% CI 0.83% to 1.14%) and 1.62% (95% CI 1.50% to 1.74%) per year, respectively. These decreases were ubiquitous worldwide. However, unfavourable trends in the ASIR of laryngeal cancer were also observed in a total of 51 developing countries.

CONCLUSIONS

The incidence and mortality rates of laryngeal cancer have significantly decreased at the global level and in most countries over the past three decades. The regions that showed an increasing incidence trend deserve more attention.

Apatinib combined with concurrent chemoradiotherapy in patients with subglottic small cell carcinoma: a case report

Subglottic small cell carcinoma (SSMCC) is a rare type of neoplasm, meaning that laryngeal cancer guidelines in several countries, including the National Comprehensive Cancer Network (NCCN) guidelines, do not include treatment principles for SSMCC. Angiogenesis is an established factor in tumor initiation, growth, and dissemination. Apatinib mesylate, an orally administered drug, is a novel inhibitor of vascular endothelial growth factor receptor-2, a key mediator of angiogenesis, and has been shown to be safe and efficacious in the treatment of certain types of malignant tumors. To the best of our knowledge, there are few reports on the treatment of SSMCC with apatinib combined with concurrent chemoradiotherapy. In the present report of SSMCC in a 64-year-old woman, oral apatinib was given daily at a dose of 250 mg in combination with concurrent chemoradiotherapy; the only toxicities reported were mild leukopenia and finger numbness. Clear and rapid efficacy was observed with the disappearance of the tumor mass. Our findings indicate that apatinib combined with concurrent chemoradiotherapy may be effective in patients with SSMCC, with adverse reactions within the manageable range, thus representing an additional treatment option for this type of malignancy.

T1a Glottic Cancer: Advances in Vocal Outcome Assessment after Transoral CO2-Laser Microsurgery Using the VEM

Patients with unilateral vocal fold cancer (T1a) have a favorable prognosis. In addition to the oncological results of CO₂ transoral laser microsurgery (TOLMS), voice function is among the outcome measures. Previous early glottic cancer studies have reported voice function in patients grouped into combined T stages (Tis, T1, T2) and merged cordectomy types (lesser- vs. larger-extent cordectomies). Some authors have questioned the value of objective vocal parameters. Therefore, the purpose of this exploratory prospective study was to investigate TOLMS-associated oncological and vocal outcomes in 60 T1a patients, applying the ELS protocols for cordectomy classification and voice assessment. Pre- and postoperative voice function analysis included: Vocal Extent Measure (VEM), Dysphonia Severity Index (DSI), auditory-perceptual assessment (GRB), and 9-item Voice Handicap Index (VHI-9i). Altogether, 51 subjects (43 male, eight female, mean age 65 years) completed the study. The 5-year recurrence-free, overall, and disease-specific survival rates (Kaplan–Meier method) were 71.4%, 94.4%, and 100.0%. Voice function was preserved; the objective parameter VEM (64 ± 33 vs. 83 ± 31; mean ± SD) and subjective vocal measures (G: 1.9 ± 0.7 vs. 1.3 ± 0.7; VHI-9i: 18 ± 8 vs. 9 ± 9) even improved significantly (p < 0.001). The VEM best reflected self-perceived voice impairment. It represents a sensitive measure of voice function for quantification of vocal performance.

Impact of Prior Cancer on the Prognosis of Patients With Laryngeal Cancer: A Population-Based Study Using the Surveillance, Epidemiology, and End Results Database

Background: Little is known about the clinical significance of laryngeal cancer as a subsequent tumor. We aimed to determine the impact of a prior cancer history on the prevalence and prognosis of patients with laryngeal cancer. Methods: We retrospectively reviewed patients diagnosed with laryngeal cancer between 2004 and 2011 in the Surveillance, Epidemiology, and End Results (SEER) database. The t-test and chi-squared test were used to compare variables as appropriate. Matched 1:1 case control-adjusted Kaplan-Meier analyses and Cox regression models were performed to investigate the impact of prior cancer on overall survival (OS). Results: Among 20,987 patients with laryngeal cancer, nearly one-fifth (n = 3,915, 18.65%) had a prior cancer. The top three common prior cancers were prostate (588, 28.1%), lung and bronchus (354, 16.9%), and head and neck (306, 14.6%). A total of 73.4% of the prior cancers were diagnosed within 5 years of the laryngeal cancer diagnosis. Compared to patients without prior cancer, a worse survival was significantly associated with a prior cancer among laryngeal cancer patients, regardless of the interval time of the prior cancer (log-rank tests P < 0.001). Furthermore, prior cancer was an independent predictor of worse OS based on the Cox regression model [hazard ratio (HR) = 1.396, 95% confidence interval, 1.336-1.458]. In addition, patients with prior lung and bronchus cancer tended to have the worst survival (log-rank tests P < 0.001). Conclusions: Prior cancer has an adverse effect on clinical outcomes among patients with laryngeal cancer. These results suggest that individualized treatment should be seriously considered in patients with laryngeal cancer and a history of prior cancer, regardless of the interval time of prior cancer.

The value of narrowband imaging using the Ni classification in the diagnosis of laryngeal cancer

INTRODUCTION

Narrowband imaging (NBI) is a special endoscopic optical enhancement setting allowing better visualization of mucosal microvasculature compared to white light endoscopy. This study evaluates the validity of NBI using the Ni classification in the detection and differentiation of severe dysplasia (SD) and glottic squamous cell carcinoma (SCC).

METHODS

Patients with suspicious vocal cord lesions underwent conventional white light endoscopy followed by clinically indicated biopsy. At the same time, NBI images were obtained and graded independently. Lesions were graded from I to V according to the Ni classification and compared to histopathological findings.

RESULTS

Fifty-two patients were included in this study (40 SCC and 12 SD). The sensitivity and specificity of NBI in diagnosing laryngeal cancer was 95.0% (CI, 83.9%-99.4%) and 83.3% (CI, 51.6%-97.9%), respectively. The negative likelihood ratio was 0.06. Higher Ni grades correlated very strongly with more advanced disease.

CONCLUSIONS

NBI using the Ni classification is a sensitive diagnostic tool for the detection and differentiation of early neoplastic and preneoplastic glottic lesions. As higher Ni classification correlates strongly with advanced disease, it serves as a useful adjunct to white light endoscopy in the diagnosis of laryngeal cancer.Level of Evidence: Level IV.

Survival prediction and treatment strategies for patients with advanced laryngeal carcinoma: a population-based study

BACKGROUND

This study aimed at exploring high-risk factors associated with survival outcomes in patients with advanced primary laryngeal carcinoma and at developing and validating a survival-predicting model to help to select the appropriate treatment for each patient.

METHODS

Data of patients with advanced primary laryngeal cancer in 2003-2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. High-risk factors were identified and integrated to build a nomogram, which was internally validated using bootstrap and externally validated with a patient cohort from China. The impact of various treatments was examined on model-defined high-, moderate- and low-risk patient groups, respectively.

RESULTS

A total of 6070 patients were analyzed. Patients' age, gender, tumor T stage, N stage, and differentiation grade were recognized and integrated into the model. The concordance index of this model (0.602) was significantly higher than that of the TNM staging system (0.547). The calibration curve showed a good agreement between model-predicted and actual survival outcomes. Patients were categorized into three different subgroups with incremental risks of overall mortality. The roles of three treatment strategies in these subgroups are varied.

CONCLUSION

In this large SEER-based study, we established a practical model to predict overall survival for patients with advanced primary laryngeal cancer. For patients identified as high-risk and moderate-risk, surgery plus adjuvant therapy is recommended, while for patients in the low-risk group, surgery alone plus regular re-examination is recommended as the primary treatment strategy.

Computed tomography-derived radiomic signature of head and neck squamous cell carcinoma (peri)tumoral tissue for the prediction of locoregional recurrence and distant metastasis after concurrent chemo-radiotherapy

Introduction

In this study, we investigate the role of radiomics for prediction of overall survival (OS), locoregional recurrence (LRR) and distant metastases (DM) in stage III and IV HNSCC patients treated by chemoradiotherapy. We hypothesize that radiomic analysis of (peri-)tumoral tissue may detect invasion of surrounding tissues indicating a higher chance of locoregional recurrence and distant metastasis.

Methods

Two comprehensive data sources were used: the Dutch Cancer Society Database (Alp 7072, DESIGN) and “Big Data To Decide” (BD2Decide). The gross tumor volumes (GTV) were delineated on contrast-enhanced CT. Radiomic features were extracted using the RadiomiX Discovery Toolbox (OncoRadiomics, Liege, Belgium). Clinical patient features such as age, gender, performance status etc. were collected. Two machine learning methods were chosen for their ability to handle censored data: Cox proportional hazards regression and random survival forest (RSF). Multivariable clinical and radiomic Cox/ RSF models were generated based on significance in univariable cox regression/ RSF analyses on the held out data in the training dataset. Features were selected according to a decreasing hazard ratio for Cox and relative importance for RSF.

Results

A total of 444 patients with radiotherapy planning CT-scans were included in this study: 301 head and neck squamous cell carcinoma (HNSCC) patients in the training cohort (DESIGN) and 143 patients in the validation cohort (BD2DECIDE). We found that the highest performing model was a clinical model that was able to predict distant metastasis in oropharyngeal cancer cases with an external validation C-index of 0.74 and 0.65 with the RSF and Cox models respectively. Peritumoral radiomics based prediction models performed poorly in the external validation, with C-index values ranging from 0.32 to 0.61 utilizing both feature selection and model generation methods.

Conclusion

Our results suggest that radiomic features from the peritumoral regions are not useful for the prediction of time to OS, LR and DM.

Increasing incidence and improving survival of oral tongue squamous cell carcinoma

We evaluated changes in incidence, relative survival (RS), and conditional survival (CS) of head and neck squamous cell carcinoma (HNSCC), focusing on oral tongue squamous cell carcinoma (OTSCC). Data of 74 680 HNSCC patients from 1976 to 2015 were obtained from the Surveillance, Epidemiology, and End Results database. Five anatomical sites and their subsites were analyzed. Annual percent change (APC) of incidence was calculated. RS and CS were compared across the four decades. Adjusted hazard ratios (aHRs) of RS were evaluated using multivariate regression. OTSCC incidence decreased from 1976 (APC = −0.76, P < 0.05) but has increased since 1999 (APC = 2.36, P < 0.05). During 2006–2015, the 5-year CS exceeded 90% only for OTSCC and oropharyngeal squamous cell carcinoma (OPSCC). RS improved in OTSCC (aHR = 0.697, 95% confidence interval [CI] 0.642–0.757, P < 0.001) and OPSCC (aHR = 0.669, 95% CI 0.633–0.706, P < 0.001) during the last two decades. For both OTSCC and OPSCC, improved survival was observed regardless of treatment. Incidence and survival remained unchanged for nasopharyngeal, hypopharyngeal, and laryngeal cancers during this period. In conclusion, OTSCC incidence has been increasing since the 2000s, with improving prognosis irrespective of treatment. Given its similarity to OPSCC, OTSCC may represent an emerging HNSCC, warranting further research and clinical recognition.

Significance of examined lymph nodes number and metastatic lymph nodes ratio in overall survival and adjuvant treatment decision in resected laryngeal carcinoma

OBJECTIVE

The value of adjuvant therapy in resected laryngeal cancer remains controversial. This large SEER-based cohort study aimed to investigate the existing parameters of lymph node status that could predict survival outcomes and the prognostic value of adjuvant treatment in resected laryngeal carcinoma.

METHODS

Population-based data from the US Surveillance, Epidemiology, and End Results (SEER-18) Program on patients after laryngectomy and lymphadenectomy (2004-2015) were analyzed. The optimal cut-off values for examined lymph nodes number (ELNs) and metastatic lymph nodes ratio (MLNR) were determined using the X-tile program. Associations of ELNs and MLNR with overall survival were investigated through Cox regression analysis. A survival-predicting model was then constructed to stratified patients. The prognostic value of adjuvant therapy was evaluated in different subgroups.

RESULTS

A total of 2122 patients with resected laryngeal cancer were analyzed. A novel survival-predicting model was proposed based on ELNs, MLNR, and other clinicopathological characteristics. Patients were stratified into three subgroups with the increasing risk of death. Only patients in the high-risk group who receiving adjuvant treatment had a significantly better survival outcome than those receiving surgery alone.

CONCLUSION

A new survival-predicting model was established in this study, which was superior in assessing the survival outcomes of patients with resected laryngeal cancer. Notably, this model was also able to assist in the decision making of adjuvant therapy for patients and physicians.

Incidence and malignant transformation of glottic precursor lesions in Denmark

Objectives: Glottic precursor lesion (GPL) is a well-known premalignant condition, but the existing knowledge of incidence and malignant potential is based on subpopulation studies. In this first, nationwide study we report data from all verified cases of GPL in Denmark during a 10-year period with focus on incidence and malignant transformation of GPL.Methods: Patients were identified by a search for GPL in the time period from 01.01.2000 to 31.12.2009 using the Danish Pathology Data Base, Patobank, which is a nationwide source of all cyto- and histopathological data obtained in Denmark. Data were validated and supplemented by medical chart review.Results: A 10-year national cohort of 965 patients (median age 60 years, male-female ratio 2:1) with histologically verified GPL was analyzed. The overall malignant transformation rate was 18.3% (mild dysplasia 7.7%, moderate dysplasia 19.8%, severe dysplasia 28.5%, and carcinoma in situ 40.3%) with a median progression time of 29 months. Eighty-eight percent of patients were active or former smokers. A significantly larger proportion of male patients (24.1%) experienced malignant transformation compared to females (6.6%) (p < .001).Conclusion: This nationwide population-based study of GPL patients confirmed a stable incidence of GPL in Denmark from January 2000 to December 2009 and a considerable malignant potential, correlated to the grading of GPL according to the World Health Organization classification of laryngeal precursor lesions from 2005, WHOC2005. The recent update, WHOC2017, of low-grade versus high-grade lesions may thus contain less nuanced prognostic information than WHOC2005.Level of evidence: 2b retrospective cohort study.