Patterns of Care for T1 Glottic Squamous Cell Carcinomas from 2004-2020

Devesh Malik; Daniel Jacobs; Soraya Fereydooni; Henry S Park; Saral Mehra

doi:10.1002/lary.31363

Patterns of Care for T1 Glottic Squamous Cell Carcinomas from 2004-2020

Laryngoscope. 2024 Feb 27. doi: 10.1002/lary.31363. Online ahead of print.

Authors

Devesh Malik¹, Daniel Jacobs², Soraya Fereydooni¹, Henry S Park³, Saral Mehra²

Affiliations

¹ Yale University School of Medicine, New Haven, Connecticut, USA.
² Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
³ Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.

PMID: 38411338
DOI: 10.1002/lary.31363

Abstract

Objective(s): Describe recent national trends in overall treatment modalities for T1 glottic squamous cell carcinomas (SCC), and identify factors associated with treatment regimens.

Methods: National Cancer Database from 2004-2020 was queried for all patients with glottic cT1N0M0 SCC. Treatment patterns over time were analyzed using the Cochran-Armitage test for trend. Multivariable logistic regressions were used to determine the factors associated with treatment regimens.

Results: Of the 22,414 patients identified, most patients received RT only (57%), 21% received surgery only, and 22% received dual-modality treatment ("over-treatment"). Over the time period, there was a decreasing trend in rates of over-treatment for T1 glottic SCC (p < 0.001) and an increasing trend in surgery only (p < 0.001). Treatment in 2016-2018 (OR: 1.168 [1.004 to 1.359]), 2013-2015 (OR: 1.419 [1.221 to 1.648]), 2010-2012 (OR: 1.611 [1.388 to 1.871]), 2007-2009 (OR: 1.682 [1.450 to 1.951]), or 2004-2006 (OR: 1.795 [1.548 to 2.081]) versus 2019-2020 was associated with greater likelihood of over-treatment. T1b tumors were less likely to be over-treated (OR: 0.795 [0.707 to 0.894]) versus T1a tumors, and less likely to receive surgery first (OR: 0.536 [0.485 to 0.592]) versus T1a tumors.

Conclusion: Over-treatment for T1 glottic SCC has been declining, with increasing rates of surgery only. Year of treatment was significantly associated with the receipt of dual-modality treatment. Finally, patients with T1b disease were more likely to receive RT as the first and only treatment.

Level of evidence: 3 Laryngoscope, 2024.

Keywords: early glottic cancer; larynx; quality improvement.