title: Treatment, comorbidity and survival in stage III laryngeal cancer.
abstract: BACKGROUND
  The purpose of this study was for us to identify factors associated with survival and laryngeal function in a contemporary, population-based study of stage III laryngeal carcinoma.
  
  
  METHODS
  Patients presenting to a tertiary center with stage III laryngeal carcinoma between 1999 and 2010 were included in the study. Kaplan-Meier and Cox proportional hazards analyses were utilized.
  
  
  RESULTS
  Of 137 patients receiving either surgery ± adjuvant therapy (SURG±Adj = 24.1%), chemoradiotherapy (CRT = 32.8%), or radiotherapy alone (RT = 36.5%), 5-year cause-specific survival (5-year CSS) was 81.0% and 2-year local relapse rate was 27.5%. RT had higher recurrence (p < .01), lower 5-year CSS (90.8% vs 87.8% vs 68.9%/SURG±Adj vs CRT vs RT/p = .0026) and lower overall survival (p = .001). Adjusting for excess of severe comorbidity in the RT group, there was no difference in 5-year CSS between treatment modality.
  
  
  CONCLUSIONS
  SURG±Adj and CRT had similar survival. Severe comorbidity was associated with selection bias to RT and reduced 5-year CSS. Comorbidity is a key prognostic variable and should be considered in the interpretation of treatment outcomes.
authors.affiliation: Department of Oncology, The Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland.
authors.forename: Katie L
authors.initials: KL
authors.lastname: Connor
authors.forename: Samuel
authors.initials: S
authors.lastname: Pattle
authors.forename: Gillian R
authors.initials: GR
authors.lastname: Kerr
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Junor
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D002423:Cause of Death; D059248:Chemoradiotherapy / Q000379:methods; D003131:Combined Modality Therapy; D015897:Comorbidity; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012606:Scotland; D015996:Survival Rate; D016896:Treatment Outcome
keywords: chemoradiotherapy; comorbidity; laryngeal carcinoma; surgery; survival