Survival analysis in patients with laryngeal cancer.A retrospective cohort study at Ocean Road Cancer Institute

Abstract

Background: Laryngeal cancer (LC) represents the most common head and neck squamous cell carcinoma in Tanzania. Although global trends demonstrate declining incidence and improving outcomes, survival disparities remain substantial, largely driven by inequities in access to definitive surgical care and the increasing adoption of organ preservation strategies. In low- and middle-income countries, delayed presentation and limited access to multimodal treatment continue to affect outcomes adversely. This study aimed to identify factors associated with 5-year overall survival (OS) among patients with LC managed at a tertiary cancer center in Dar es Salaam, Tanzania, within the context of organ–preservation–based therapy. Methods: A retrospective cohort study was conducted at the Ocean Road Cancer Institute (ORCI). Medical records of 82 patients diagnosed with LC and treated between 2008 and 2012 were reviewed. The primary outcome was 5-year OS. Survival probabilities were estimated using the Kaplan–Meier method. The log-rank test was used for univariate comparisons, and multivariate analysis was performed using Cox proportional hazards regression. Results: Laryngeal squamous cell carcinoma accounted for 99% of cases and predominantly affected males (male-to-female ratio 10:1), with a mean age of 61 years. Hoarseness was the most common presenting symptom (90.2%). Most patients (72.3%) presented with advanced disease (stage III–IV). The 5-year overall survival was 29%. In multivariable Cox proportional hazards analysis, supraglottic tumor location remained independently associated with worse overall survival compared with glottic tumors (adjusted HR [aHR] 2.13, 95% CI 1.16–3.91, p = 0.015). Treatment-related factors were independently associated with improved survival, including receipt of an EQD2 dose ≥46 Gy (aHR 0.50, 95% CI 0.26–0.97, p = 0.041) and CCRT (aHR 0.46, 95% CI 0.23–0.92, p = 0.029. Conclusion:  The 5-year OS was 29%. Poor survival was independently associated with supraglottic tumor location, absence of concurrent chemotherapy, and lower total RT dose. These findings underscore the importance of optimizing definitive treatment in this setting, particularly through appropriate RT dose escalation and broader use of concurrent chemoradiotherapy. Where feasible, carefully selected patients may also benefit from timely salvage laryngectomy within an organ preservation framework to improve long-term disease control.