Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.
Department of Radiation Oncology, UT Health San Antonio, San Antonio, Texas, USA.
Otolaryngol Head Neck Surg. 2020 Jun;162(6):888-896. doi: 10.1177/0194599820907064. Epub 2020 Feb 25.
Advanced laryngeal squamous cell carcinoma remains associated with approximately 50% mortality at 5 years. Delivery of multimodality treatment remains critical to maximizing survival for this disease, but achieving this at a national level remains a difficult undertaking, particularly in under- and uninsured patients as well as minority patients. We sought to evaluate laryngeal cancer treatment delivery and clinical outcomes in a predominantly minority and underserved cohort of largely under- and uninsured patients in a county hospital.
Retrospective cohort study.
Tertiary care county hospital in Houston, Texas.
Patients (N = 210) with a new diagnosis of laryngeal squamous cell carcinoma treated between 2005 and 2015 were included in a retrospective analysis of patient demographics, tumor and treatment characteristics, and oncologic outcomes.
The majority of patients presented with advanced disease (T4 = 43%, N>0 = 45%). Treatment selection was compliant with National Comprehensive Cancer Network guidelines in 81% of cases, but 76% of patients who required adjuvant radiotherapy were unable to start it within 6 weeks postsurgery. Overall survival and disease-free survival were 52% and 63% for the entire cohort, respectively. Supraglottic subsite and nodal metastases were significantly associated with decreased overall survival and disease-free survival. Race/ethnicity and insurance status were not associated with worse oncologic outcomes.
Under- and uninsured patients often present with advanced laryngeal cancer. Oncologic outcomes in this cohort of patients is similar to that of other published series. Moreover, tumor characteristics rather than demographic variables drive oncologic outcomes for the predominantly minority and underserved patients seeking care in our tertiary care county hospital.
高级喉鳞状细胞癌患者在 5 年内的死亡率仍约为 50%。为了最大限度地提高生存率，需要对患者进行多模式治疗，但在全国范围内实现这一目标仍然具有挑战性，尤其是在未参保和无保险的患者以及少数民族患者中。我们旨在评估在一个以少数民族和服务不足为主的人群中，主要是未参保和无保险的患者中，在一家县级医院进行的喉癌治疗情况和临床结果。
回顾性队列研究。
德克萨斯州休斯顿的三级保健县级医院。
2005 年至 2015 年间，有 210 名新诊断为喉鳞状细胞癌的患者接受了回顾性分析，分析内容包括患者的人口统计学、肿瘤和治疗特征以及肿瘤学结果。
大多数患者就诊时处于晚期疾病（T4 = 43%，N>0 = 45%）。在 81%的病例中，治疗选择符合国家综合癌症网络指南，但有 76%需要辅助放疗的患者在手术后 6 周内无法开始放疗。整个队列的总生存率和无病生存率分别为 52%和 63%。声门上亚部位和淋巴结转移与总生存率和无病生存率降低显著相关。种族/族裔和保险状况与肿瘤学结果无显著相关性。
未参保和无保险的患者常就诊于晚期喉癌。在这个主要由少数民族和服务不足的患者组成的患者队列中，肿瘤学结果与其他已发表的系列相似。此外，在我们的三级保健县级医院寻求治疗的以少数民族和服务不足为主的患者中，肿瘤特征而不是人口统计学变量决定了肿瘤学结果。
