title: Treatment delay and facility case volume are associated with survival in early-stage glottic cancer.
abstract: To identify and compare treatment and system factors associated with survival in early-stage glottic cancer.
  
  
  
  Retrospective study of cases in the Commission on Cancer National Cancer Database.
  
  
  
  Adult patients with early glottic cancer (stage I or II) diagnosed between January 1, 2004, and December 31, 2012, were included. Demographic, tumor, and survival variables were included in the analyses. Multivariate Cox regressions as well as univariate Kaplan-Meier analyses were conducted.
  
  
  
  In total, 5,627 patients were included in the study. Treatment factors associated with improved survival included larynx-preserving surgery alone (hazard ratio [HR] 0.740; P = 0.001) and larynx-preserving surgery with radiation (HR 0.837; P = 0.010) when compared to radiotherapy alone. System factors associated with worse survival included intermediate- (HR 1.123; P = 0.047) or low- (HR 1.458; P = 0.017) volume centers; Medicaid (HR 1.882; P < 0.001), Medicare (HR 1.532; P < 0.001), or other government insurance (HR 2.041; P < 0.001); and delay between diagnosis and treatment greater than 100 days (HR 1.605; P = 0.006).
  
  
  
  A number of treatment and system factors were found to be significantly associated with survival when controlling for patient and tumor factors. These may present targets for the improvement of outcomes in early-stage glottic cancers.
  
  
  
  4. Laryngoscope, 127:616-622, 2017.
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Shayan
authors.initials: S
authors.lastname: Cheraghlou
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Phoebe
authors.initials: P
authors.lastname: Kuo
authors.affiliation: Department of Surgery, Yale School of Medicine, New Haven, Connecticut, U.S.A.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Judson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D055088:Early Detection of Cancer; D005260:Female; D005931:Glottis / Q000473:pathology / Q000601:surgery; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D007825:Laryngectomy / Q000379:methods / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000401:mortality; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014850:Waiting Lists
keywords: Glottic cancer; NCDB; facility case volume; survival; treatment delay