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Survival after refusal of surgical treatment for locally advanced laryngeal cancer.

Publication ,  Journal Article
Massa, ST; Osazuwa-Peters, N; Franco, J; Ward, GW; Walker, RJ
Published in: Oral Oncol
August 2017

OBJECTIVE: Survival of advanced laryngeal cancer is declining while the popularity of organ preservation protocols grows. This study assesses the survival impact of refusing surgical treatment for locally advanced, resectable laryngeal cancer. METHODS: Adult patients with T3 and T4a non-metastatic laryngeal squamous cell carcinoma were identified from the Surveillance, Epidemiology and End Results 18 database from 2004 to 2013. Patients were stratified based on a recommendation for extirpative surgery and the refusal of surgery. Multivariate logistic regression modeling identified variables associated with refusal. A multivariate cox proportional hazard model produced adjusted Kaplan-Meier survival curves. Survival was compared using adjusted hazard ratios (aHR) with 95% confidence intervals (CI). RESULTS: Of 5786 patients in the study, 2877 were recommended for surgical treatment and 138 (4.8%) refused. Refusal of surgery was associated with unmarried status (Single, odds ratio (OR) 1.79, CI 1.10-2.92), black race (OR 1.50, CI 1.00-2.22), T3 tumors (OR 1.80, CI 1.26-2.61) and N3 nodal disease (OR 3.50, CI 1.24-8.48). Compared to patients undergoing surgery, those who refused had lower 5-year cancer specific survival and increased hazard of cancer-specific mortality (aHR 1.60, CI 1.24-2.07) which resulted in decreased 5-year survival (50.0vs 60.1%), after controlling for other factors. CONCLUSION: Refusal of surgery for locally advanced laryngeal cancer is more common in patients without marital support and with T3 tumors. This decision results in a 10% survival decrease at 5-year. Future study is needed to understand patients' reasoning behind this decision and to investigate additional factors not available in this dataset.

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Published In

Oral Oncol

DOI

EISSN

1879-0593

Publication Date

August 2017

Volume

71

Start / End Page

34 / 40

Location

England

Related Subject Headings

  • Treatment Refusal
  • Survival Analysis
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Laryngeal Neoplasms
  • Humans
  • Female
  • Dentistry
  • Cohort Studies
 

Citation

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Massa, S. T., Osazuwa-Peters, N., Franco, J., Ward, G. W., & Walker, R. J. (2017). Survival after refusal of surgical treatment for locally advanced laryngeal cancer. Oral Oncol, 71, 34–40. https://doi.org/10.1016/j.oraloncology.2017.05.019
Massa, Sean T., Nosayaba Osazuwa-Peters, Joel Franco, Gregory W. Ward, and Ronald J. Walker. “Survival after refusal of surgical treatment for locally advanced laryngeal cancer.Oral Oncol 71 (August 2017): 34–40. https://doi.org/10.1016/j.oraloncology.2017.05.019.
Massa ST, Osazuwa-Peters N, Franco J, Ward GW, Walker RJ. Survival after refusal of surgical treatment for locally advanced laryngeal cancer. Oral Oncol. 2017 Aug;71:34–40.
Massa, Sean T., et al. “Survival after refusal of surgical treatment for locally advanced laryngeal cancer.Oral Oncol, vol. 71, Aug. 2017, pp. 34–40. Pubmed, doi:10.1016/j.oraloncology.2017.05.019.
Massa ST, Osazuwa-Peters N, Franco J, Ward GW, Walker RJ. Survival after refusal of surgical treatment for locally advanced laryngeal cancer. Oral Oncol. 2017 Aug;71:34–40.
Journal cover image

Published In

Oral Oncol

DOI

EISSN

1879-0593

Publication Date

August 2017

Volume

71

Start / End Page

34 / 40

Location

England

Related Subject Headings

  • Treatment Refusal
  • Survival Analysis
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Laryngeal Neoplasms
  • Humans
  • Female
  • Dentistry
  • Cohort Studies