title: Racial disparities in laryngeal cancer treatment and outcome: A population-based analysis of 24,069 patients.
abstract: OBJECTIVE
  To determine the impact of race on laryngeal preservation strategies and overall survival (OS) for laryngeal squamous cell carcinoma (SCC).
  
  
  METHODS
  Retrospective, national cancer database analysis.
  
  
  METHODS
  Data were extracted from the Surveillance, Epidemiology, and End Results database. Chi-square test, Kaplan-Meier method, and Cox regression models were employed in SPSS 20.0 (Armonk, NY: IBM Corp.) for data analyses.
  
  
  RESULTS
  A total of 24,069 patients with laryngeal SCC were identified. Of these, 18,166 (75.5%) patients were white, 3,475 (14.4%) were black, 1,608 (6.7%) were Hispanic, and 820 (3.4%) were Asian. Compared with other races, black patients were more likely to be diagnosed at a younger age (P < 0.001), undergo lymph node dissection (P < 0.001), have nodal metastasis (P < 0.001), be with advanced stage disease (P < 0.001), and be unmarried (P < 0.001). Black patients with T1 to T2 and T3 disease were more likely to undergo total laryngectomy as compared with white patients (T1-2: 8.2% vs. 4.3%; P < 0.001; T3: 28.4% vs. 24.3%; P = 0.023). For patients with T4 disease, however, rates of primary radiotherapy among black patients were higher (40.5% vs. 35.7%; P = 0.015). The 5-year OS for white, black, Hispanic, and Asian patients were 60.6%, 52.7%, 59.5% and 65.7% (P < 0.001). This significant 5-year OS difference by race persisted regardless of age, gender, year of diagnosis, primary treatment, nodal status, or tumor grade. On multivariate analysis, race remained an independent prognostic factor for OS.
  
  
  CONCLUSIONS
  Race is an independent prognostic factor for OS. Further studies are warranted to evaluate causes for racial disparities and discrepancies in OS and laryngeal preservation strategies.
authors.affiliation: Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, U.S.A.
authors.forename: Jacob Y
authors.initials: JY
authors.lastname: Shin
authors.affiliation: Department of Radiation Oncology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, U.S.A.|Department of Radiology, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, U.S.A.
authors.forename: Minh T
authors.initials: MT
authors.lastname: Truong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000208:ethnology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011159:Population Surveillance; D044469:Racial Groups; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Laryngeal cancer; disparities; outcomes; race; treatment