Does Subglottic Squamous Cell Carcinoma Warrant a Different Strategy Than Other Laryngeal Subsites

OBJECTIVES/HYPOTHESIS Subglottic squamous cell carcinoma (SSCC) is a rare cancer with limited evidence-based treatment guidelines. This study aimed to describe the treatment patterns for SSCC and to determine which treatments provide the best overall survival. STUDY DESIGN Retrospective database review. METHODS The National Cancer Database (NCDB) was queried for patients treated for SSCC from 2004 through 2014. Overall survival (OS) rates were determined by the Kaplan-Meier method. Clinicopathologic characteristics were assessed by univariable and multivariable Cox proportional hazards models, which corrected for age, sex, race, insurance status, income quartile, residence, Charlson-Deyo comorbidity score, facility type providing treatment, tumor grade, and clinical N and T category. RESULTS In this cohort of 549 patients with SSCC, the 5-year OS was 48.2%. SSCC presented at an advanced stage (American Joint Committee on Cancer stage III or IV) in 60.1% of cases; 78.3% of cases had no nodal metastases. Among only stage IV cases, multivariable analysis showed that radiotherapy (RT) (hazard ratio [HR] = 5.944; 95% confidence interval [CI]: 2.76-12.8; P < .001) and chemoradiotherapy (CRT) (HR = 2.321; 95% CI: 1.36-3.97; P = .002) were both associated with decreased 5-year OS compared to a group consisting of all surgeries. When this analysis was repeated for only stage III cases, RT (HR = 1.134; 95% CI: 0.38-3.37; P = .821) and CRT (HR = 1.784; 95% CI: 0.78-4.08; P = .170) were equivalent to surgery. CONCLUSIONS Using the NCDB to study the largest cohort of SSCC with known staging and treatment, primary surgery may provide a better 5-year OS in advanced-stage SSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 2020.