Physical activity and laryngeal cancer

A deep learning-based model predicts survival for patients with laryngeal squamous cell carcinoma: a large population-based study

OBJECTIVES

To assess the performance of DeepSurv, a deep learning-based model in the survival prediction of laryngeal squamous cell carcinoma (LSCC) using the Surveillance, Epidemiology, and End Results (SEER) database.

METHODS

In this large population-based study, we developed and validated a deep learning survival neural network using pathologically diagnosed patients with LSCC from the SEER database between January 2010 and December 2018. Totally 13 variables were included in this network, including patients baseline characteristics, stage, grade, site, tumor extension and treatment details. Based on the total risk score derived from this algorithm, a three-knot restricted cubic spline was plotted to exhibit the difference of survival benefits from two treatment modalities.

RESULTS

Totally 6316 patients with LSCC were included in the study, of which 4237 cases diagnosed between 2010 and 2015 were selected as the development cohort, and the rest (2079 cases diagnosed from 2016 to 2018) were the validation cohort. A state-of-the-art deep learning-based model based on 23 features (i.e., 13 variables) was generated, which showed more superior performance in the prediction of overall survival (OS) than the tumor, node, and metastasis (TNM) staging system (C-index for DeepSurv vs TNM staging = 0.71; 95% CI 0.69-0.74 vs 0.61; 95% CI 0.60-0.63). Interestingly, a significantly nonlinear association between total risk score and treatment effectiveness was observed. When the total risk score ranges 0.1-1.5, surgical treatment brought more survival benefits than nonsurgical one for LSCC patients, especially in 70.5% of patients staged III-IV.

CONCLUSIONS

The deep learning-based model shows more potential benefits in survival estimation for patients with LSCC, which may potentially serve as an auxiliary approach to provide reliable treatment recommendations.

Advances in Organ Preservation for Laryngeal Cancer

OPINION STATEMENT

At the University of Wisconsin, all treatment of head and neck cancer patients begins with discussion at our multi-disciplinary tumor board. Most patients with T4 disease, with existing laryngeal dysfunction, considered unlikely to complete definitive CRT or who have a high risk of persistent aspiration after non-operative management undergo total laryngectomy. A laryngeal sparing approach is attempted on most other patients. Radiotherapy is delivered over 6.5 weeks, preferably with concurrent weekly cisplatin. If the patient is hesitant of chemotherapy or has contraindications to cisplatin, concurrent cetuximab may be offered. Patients treated with RT alone are often treated to the same dose, but via an accelerated schedule by adding a 6th fraction per week. The 6th fraction is given by delivering two treatments at least 6 h apart on a weekday of the patient's choosing. We consider the following to be major risk factors for clinically significant weight loss during treatment: a 10% or greater loss of weight in the 6 months prior to starting treatment, delivery of concurrent cisplatin, and treatment of the bilateral neck with radiation. Patients who have 2-3 of these characteristics are often given gastrostomy tubes prophylactically. Patients are seen 2 weeks after completion of therapy, and then every 3 months after completion for 2 years. A CT neck and PET-CT are performed at the first 3-month visit. They are seen twice in year three, and then yearly until years 5-7. At each of these visits, we have a low threshold to present the patient at our multidisciplinary tumor board for consideration of salvage laryngectomy if there are signs of progression.

A dynamic prognostic nomogram to predict the benefit from surgical treatment modality for patients with laryngeal squamous cell carcinoma

BACKGROUND

Although nonsurgical treatment strategy is increasingly adopted in patients with locoregionally advanced laryngeal squamous cell carcinoma (LSCC), survival disparities were reported between surgical treatment modality and organ preservation protocols, highlighting the great importance for accurate patients' selection.

METHOD

This secondary analysis used data from the Surveillance, Epidemiology, and End Results database between 2010 and 2015 with follow-up data up to 2018. We developed and validated a dynamic prognostic nomogram for overall survival (OS) in 4237 patients with LSCC and subgroup of 2087 patients with locoregionally advanced laryngeal squamous cell carcinoma (LALSCC). Based on the total risk score derived from the dynamic nomogram, two well-matched risk groups (i.e., low- and high-risk) were created via X-tile software and 1-to-1 propensity score matching (PSM); surgical treatment modality was compared with nonsurgical one in each risk group.

RESULTS

A more accurate and convenient dynamic prognostic nomogram based on age, marital status, T category, N category, M category, tumor size, and tumor differentiation was developed and validated, of which the predictive performance was superior to that of TNM staging system. For high-risk LALSCC selected by the dynamic nomogram, after 1-to-1 PSM, significantly improved OS was observed in patients with receiving surgical treatment compared to those receipt of nonsurgical management (restricted mean survival time at 36-month: 26.6 vs 22.7, p < 0.001; restricted mean survival time at 60-month: 36.7 vs 31.0, p = 0.003).

CONCLUSION

We establish and validate a more accurate and convenient dynamic prognostic nomogram for patients with LSCC, which may predict the benefit from surgical treatment modality for patients with high-risk LALSCC.

Incidence and mortality of laryngeal cancer in China, 2015

Objective

Using data from cancer registries to estimate laryngeal cancer incidence and mortality in China, 2015.

Methods

Data submitted from 501 cancer registries were checked and evaluated according to the criteria of data quality control and 368 registries’ data were qualified for the final analysis. Data were stratified by area (urban/rural), sex, age group and combined with national population data to estimate laryngeal cancer incidence and mortality in China, 2015. China population census in 2000 and Segi’s population were used for age-standardized.

Results

The percentage of cases morphological verified (MV%) of laryngeal cancer was 74.18%. The percentage of death certificate-only cases (DCO%) was 2.10%. And the mortality to incidence (M/I) ratio was 0.55. About 25,300 new cases of laryngeal cancer were diagnosed in 2015 and 13,700 deaths were reported. The crude rate of laryngeal cancer was 1.84 per 100,000 (males and females were 3.20 and 0.42 per 100,000, respectively). Age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) were 1.18 and 1.19 per 100,000, respectively. The cumulative incidence rate (0−74 years old) was 0.15%. The crude mortality rate was 1.00 per 100,000. Age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) were 0.61 and 0.61 per 100,000, respectively, with the cumulative rate (0−74 years old) was 0.07%. Incidence and mortality of laryngeal cancer in males were higher than those in females. And the rates in urban areas were higher than those in rural areas.

Conclusions

The incidence and mortality of laryngeal cancer in China were low. And the rates were significantly higher in males than in females. Risk factor control and targeted prevention should be strengthened.