Investigation of Recurrence Rate and Associated Risk Factors of Laryngeal Squamous Cell Carcinoma in Patients Undergoing Transoral Laser Microsurgery: A Retrospective Cohort Study

TL;DR

This study examines how often laryngeal cancer returns after surgery and finds that smoking significantly increases the risk of recurrence.

Contribution

The study identifies smoking as a critical modifiable risk factor for recurrence after transoral laser microsurgery for laryngeal cancer.

Findings

The recurrence rate was 26.1%, with local recurrence being the most common.

Smoking exposure was significantly associated with higher recurrence risk.

Disease-free survival probability was approximately 0.75 at 80 months.

Abstract

Laryngeal squamous cell carcinoma (SCC) remains a significant health challenge, with transoral laser microsurgery (TLM) emerging as a preferred treatment for early-stage disease. This retrospective cohort study investigates recurrence patterns, survival outcomes, and prognostic factors in patients treated with TLM, with a focus on the role of smoking exposure.

A retrospective cohort study was conducted on 142 patients with laryngeal SCC treated with TLM at Rasoul Akram Hospital (2016–2022). Patient demographics, tumor characteristics, smoking history (Pack-Years), and follow-up data were analyzed. Recurrence rates and survival were assessed using Kaplan-Meier analysis, and risk factors were evaluated using univariate logistic regression and Cox proportional hazards models.

The recurrence rate was 26.1% (n=37), predominantly local (70.3%), with a median time to recurrence of 15 months. Smoking exposure significantly correlated with recurrence risk (OR=1.02, 95% CI: 1.00–1.03, p=0.02; HR=1.01, 95% CI: 1.00–1.02, p=0.04). Kaplan-Meier analysis revealed reduced recurrence-free survival for patients with >20 Pack-Years (p=0.04), while disease-free survival (DFS) probability was approximately 0.75 at 80 months. No significant associations were found for age, sex, tumor stage, or comorbidities (all p>0.05), and no distant metastases were observed.

TLM appears to be an effective treatment for early-stage laryngeal SCC in this cohort, with smoking identified as a critical modifiable risk factor for recurrence. The findings underscore the importance of smoking cessation interventions to enhance outcomes. Given the retrospective and single-center design, conclusions should be interpreted cautiously. Future multi-center studies with extended follow-up and molecular profiling are recommended.

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