title: Improvements in survival and disparities for advanced-stage laryngeal cancer.
abstract: OBJECTIVE
  Laryngeal cancer survival rates have declined over the past 2 decades. Primary surgical therapy may increase survival rates in advanced-stage tumors.
  
  
  OBJECTIVE
  To compare survival outcomes for initial surgical treatment of advanced-stage primary tumors in the Louisiana health system with outcomes in the National Cancer Database (NCDB).
  
  
  METHODS
  Retrospective analysis was conducted at an academic tertiary referral hospital. Patients diagnosed as having laryngeal carcinoma between 1998 and 2007 were identified via a tumor registry. Louisiana State University Health-Shreveport (LSU Health) data and national data from 2000 to 2010 were obtained from the NCDB of the American College of Surgeons.
  
  
  METHODS
  Treatment of laryngeal cancer.
  
  
  METHODS
  Age, sex, race/ethnicity, socioeconomic status, laryngeal subsite, stage, primary treatment modality, and observed survival were analyzed and compared.
  
  
  RESULTS
  A total of 165 patients treated at LSU Health met the inclusion criteria. One hundred seventeen (70.91%) presented with advanced-stage (III/IV) disease, compared with 46.67% nationwide (P < .01). For stage IV disease our 5-year survival rate was 55.54% (95% CI, 43.35%-66.11%)compared with 31.60% (95% CI, 30.40%-32.90%) nationally (P < .05). Our proportion of uninsured patients was 23.73% vs 5.05% of patients nationally (P < .001), and our patients traveled further distances for care with 60.47% traveling 50 miles or more, compared with 15.87% nationally (P < .001). Sixty-four of the patients with advanced-stage disease (54.70%) underwent primary surgical therapy to include total laryngectomy. Data from the NCDB indicate that the rate of laryngectomy declined from 40% to 60% in the 1980s to 32% in 2007.
  
  
  CONCLUSIONS
  Louisiana State University Health-Shreveport treated more uninsured patients with advanced-stage laryngeal cancer compared with national data but demonstrated higher survival rates for those with advanced-stage disease. The results also demonstrate that we have continued a high rate of primary surgical therapy for advanced-stage disease, despite the national trend toward organ preservation. We believe that upfront laryngectomy may explain our higher survival rates for advanced-stage laryngeal cancer.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana.
authors.forename: Blake Joseph
authors.initials: BJ
authors.lastname: LeBlanc
authors.affiliation: Department of Medicine, Louisiana State University Health-Shreveport, Shreveport.
authors.forename: Runhua
authors.initials: R
authors.lastname: Shi
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana.
authors.forename: Vikas
authors.initials: V
authors.lastname: Mehta
authors.affiliation: Department of Oncology, Louisiana State University Health-Shreveport, Shreveport.
authors.forename: Glenn
authors.initials: G
authors.lastname: Mills
authors.affiliation: Department of Radiation Oncology, Louisiana State University Health-Shreveport, Shreveport.
authors.forename: Federico
authors.initials: F
authors.lastname: Ampil
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health-Shreveport, Shreveport, Louisiana.
authors.forename: Cherie-Ann O
authors.initials: CA
authors.lastname: Nathan
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D007825:Laryngectomy / Q000706:statistics & numerical data; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D017678:Sex Distribution; D014195:Travel; D014481:United States / Q000453:epidemiology