Department of Otolaryngology, Head and Neck Surgery, Columbia University Irving Medical Center, New York, New York, USA.
Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
J Surg Oncol. 2021 Dec;124(8):1272-1283. doi: 10.1002/jso.26643. Epub 2021 Aug 14.
The impact of travel distance on stage at presentation and management strategies of laryngeal squamous cell carcinoma (SCC) is unknown. We investigated this relationship.
Retrospective review of patients with laryngeal SCC in the National Cancer Data Base from 2004 to 2016. Multivariate analysis determined relationships between travel distance, sociodemographic, geographic, and hospital factors. Logistic regression determined the influence of travel distance on T-stage and overall stage at presentation, and receipt of total laryngectomy.
Sixty thousand four hundred and thirty-nine patients were divided into groups based on distance to treatment: short (<12.5 miles); intermediate (12.5-49.9 miles); and long (>50 miles). Increased travel was associated with T4-stage (intermediate vs. short OR 1.11, CI 1.04-1.18, p = 0.001; long vs. short OR 1.5, CI 1.36-1.65, p < 0.001), and total laryngectomy (intermediate vs. short OR 1.40, CI 1.3-1.5, p ≤ 0.001; long vs. short OR 2.52, CI 2.28-2.79, p ≤ 0.001). In T4 disease, total laryngectomy was associated with improved survival compared to nonsurgical treatment (HR 0.75, CI 0.70-0.80, p < 0.001) regardless of travel distance.
Longer travel distance to care is associated with increased stage at presentation, rate of laryngectomy, and improved survival in advanced laryngeal SCC. Health policy efforts should be directed towards improving early access to diagnosis and care.
旅行距离对喉鳞状细胞癌（SCC）表现分期和管理策略的影响尚不清楚。我们对此进行了研究。
回顾性分析 2004 年至 2016 年国家癌症数据库中患有喉 SCC 的患者。多变量分析确定了旅行距离、社会人口统计学、地理位置和医院因素之间的关系。逻辑回归确定了旅行距离对 T 分期和总体分期以及全喉切除术的影响。
将 6439 名患者根据治疗距离分为三组：短距离（<12.5 英里）；中距离（12.5-49.9 英里）；长距离（>50 英里）。随着旅行距离的增加，T 期（中距离与短距离 OR 1.11，CI 1.04-1.18，p=0.001；长距离与短距离 OR 1.5，CI 1.36-1.65，p<0.001）和全喉切除术（中距离与短距离 OR 1.40，CI 1.3-1.5，p≤0.001；长距离与短距离 OR 2.52，CI 2.28-2.79，p≤0.001）的发生率增加。在 T4 期疾病中，与非手术治疗相比，全喉切除术与生存改善相关（HR 0.75，CI 0.70-0.80，p<0.001），而与旅行距离无关。
到治疗地点的旅行距离越长，喉 SCC 表现分期越高，接受喉切除术的比例越高，生存率越高。卫生政策的努力应致力于改善早期获得诊断和治疗的机会。
