COMPARATIVE EFFECTIVENESS OF SURGICAL VERSUS NONSURGICAL THERAPY FOR LARYNGEAL AND OROPHARYNGEAL CANCER.
Author(s)
Campolina AG1, Lopez RV2, Lopes EF2, Hoff PM2, Chammas R2
1Cancer Institute of the State of Sao Paulo, Sao Paulo, Brazil, 2Cancer Institute of the State of São Paulo, Sao Paulo, Brazil
OBJECTIVES: The treatment of patients with laryngeal and oropharyngeal cancer includes surgery or concurrent chemoradiation (CRT). Although CRT has become more common in recent years, the effectiveness of complete CRT in improving survival over surgery is not clear. The aim of this study was to evaluate the impact of CRT on mortality rates for laryngeal and oropharyngeal cancer using a validated approach. METHODS: This was a hospital-based cancer registry (HBCR) study carried out at a referential cancer hospital in Sao Paulo, Brazil, between 2008-2012. Records were retrieved and information about patients with head and neck squamous cell carcinoma (oropharynx and larynx), over 18 years old, were included in the analysis. A propensity score-matched logistic regression analyses were conducted to compare overall mortality rates between treatment modalities, adjusting for patient sociodemographic and clinical characteristics (age, gender, year of diagnose, tumor site and clinical staging). Conditional logistic regression for vital status as outcome was performed after matched by propensity scores. RESULTS: Of the 694 patients in the study cohort, 34% underwent surgery and 66% underwent CRT. In traditional analysis, patients who underwent CRT had almost three-fold to die compared with patients in surgical treatment (OR [odds ratio] 2.9; 95%CI 1.9-4.3). Using propensity score approach, the odds for CRT was 3.6 (95%CI 1.8-6.9). CONCLUSIONS: Patients who underwent complete CRT were found to have overall mortality rates different to those of patients undergoing surgery. Although CRT provides organ preservation, the benefits and trade-offs of CRT and total laryngectomy should be discussed fully with patients.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PCN19
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Oncology