Nonsquamous cell laryngeal cancers: Incidence, demographics, care patterns, and effect of surgery

• Published in: The Laryngoscope Vol. 129; no. 11; pp. 2496 - 2505
• Main Authors: Torabi, Sina J., Cheraghlou, Shayan, Kasle, David A., Savoca, Emily L., Judson, Benjamin L.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-11-2019; Wiley Subscription Services, Inc
• Subjects: Adolescent; Adult; Aged; Databases, Factual; Female; Head & neck cancer; head and neck cancer; Humans; Incidence; Laryngeal cancer; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - pathology; Laryngeal Neoplasms - surgery; Laryngectomy - methods; Laryngectomy - mortality; Male; Medical prognosis; Metastasis; Middle Aged; Multivariate Analysis; National Cancer Database; Neoplasm Metastasis; Neuroendocrine tumors; Neuroendocrine Tumors - mortality; Neuroendocrine Tumors - surgery; Nonsquamous cell laryngeal cancers; Proportional Hazards Models; Regression Analysis; Retrospective Studies; Surgery; Survival Rate; Treatment Outcome; Young Adult; laryngeal cancer; National Cancer Database; head and neck cancer; Nonsquamous cell laryngeal cancers
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.27785

Objectives
To analyze the incidence and clinical profile of nonsquamous cell (non‐SCC) laryngeal carcinomas and to analyze the effect of surgery on survival.
Study Design
A retrospective analysis of the National Cancer Database (2004–2014).
Methods
Adult patients with non‐SCC laryngeal cancers were divided into six major histological subtypes. A descriptive clinical profile was obtained for non‐SCC patients, and multivariate regressions were performed to analyze the effect of surgery on survival within the non‐SCC cohort.
Results
We identified 878 cases of non‐SCC laryngeal cancers, representing 1.02% of all malignant laryngeal cancers. Neuroendocrine tumors and bone/cartilage sarcomas made up the largest groups (37.02% and 32.35%, respectively). Metastasis (M) was higher in neuroendocrine tumors, representing 19.1% of those with known clinical M stages. Of those treated, the majority of patients with bone/cartilage sarcomas (80.9%) and minor salivary gland tumors (82.6%) received surgery as part of their treatment. Survival varied significantly based upon histology, with bone/cartilage sarcomas having the highest 5‐year survival at 90.4%, and neuroendocrine tumors exhibiting the poorest 5‐year survival at 25.7%. Multivariate analyses found surgery to be significantly associated with improved survival (hazard ratio: 0.679; 95% confidence interval: 0.472–0.976; P = 0.036). The specific surgical method (i.e., local excision vs. partial vs. total laryngectomy) did not have any effect on survival.
Conclusion
Approximately 1% of all malignant laryngeal cancers are non‐SCC in origin. At presentation, neuroendocrine tumors have the highest rate of distant metastasis and have the worst prognosis of the non‐SCC cancers. Most non‐SCC patients received surgery as part of their treatment regimen.
Level of Evidence
NA. Laryngoscope, 129:2496–2505, 2019