title: Geographic trends in management of early-stage laryngeal cancer.
abstract: OBJECTIVE
  The goal of the study was to identify geographic trends in the primary treatment of early-stage glottic cancer.
  
  
  METHODS
  Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End-Results (SEER) database.
  
  
  METHODS
  Using the most up-to-date November 2014 submission of the SEER database in addition to SEER-18 data files, a cohort was created of stage I to II squamous cell glottic cancer from 2004 to 2012. The treatment groups (radiation and surgery) were compared with respect to several pretreatment covariates including age, race, gender, state where they received treatment, year of diagnosis, and American Joint Committee on Cancer (AJCC) stage.
  
  
  RESULTS
  In analyzing geographic trends, a statistically significant difference in treatment received by region and state was found (P < .0001.). When examining patient demographics, there was no statistically significant difference in treatment by age (P = .5206), AJCC stage (P = .4922), or year of diagnosis (P = .6593). There was a significant difference in racial distribution by treatment (P = .0038), with patients receiving surgery more likely to be black than patients receiving radiation (12% vs. 10%). In analyzing overall survival (OS), there was no significant difference in OS among the four US treatment regions (P = .2508).
  
  
  CONCLUSIONS
  Geographic factors impact overall treatment of early-stage glottic cancer. In addition, it was determined that race was a factor that correlated to differences in treatment modality. Finally, overall survival across the United States was determined to be significantly better in patients receiving radiation therapy.
  
  
  METHODS
  4 Laryngoscope, 126:880-884, 2016.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mt. Sinai, New York, New York.
authors.forename: Moustafa
authors.initials: M
authors.lastname: Mourad
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Aaron
authors.initials: A
authors.lastname: Dezube
authors.affiliation: Department of Biostatistics, Icahn School of Medicine at Mt. Sinai, New York, New York, U.S.A.
authors.forename: Erin
authors.initials: E
authors.lastname: Moshier
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mt. Sinai, New York, New York.
authors.forename: Edward
authors.initials: E
authors.lastname: Shin
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018426:SEER Program; D012737:Sex Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
keywords: Laryngeal cancer; epidemiology; glottic cancer; squamous cell carcinoma; surgery compared to radiation