The primary tumor resection in patients with distant metastatic laryngeal carcinoma
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HEAD AND NECK
The primary tumor resection in patients with distant metastatic laryngeal carcinoma Zhongyang Lin1 · Hanqing Lin2 · Xihang Chen1 · Yuanteng Xu1 · Xiaobo Wu1 · Xiaoying Ke1 · Chang Lin1 Received: 15 February 2020 / Accepted: 15 April 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background The role of primary tumor resection in patients with distant metastatic laryngeal carcinoma (DMLC) has not been clarified completely. Thus, we used propensity score matching (PSM) and survival analysis to address this issue. Methods The PSM was utilized to avoid selection bias and disproportionate distributions of the confounding factors. Kaplan– Meier estimates and Cox proportional hazard analysis were utilized to evaluate overall survival (OS) and cancer-specific survival (CSS). Results From the Surveillance, Epidemiology, and End Results Program database, a cohort of 480 patients with DMLC were included. After PSM, the OS and CSS for patients who underwent resection were significantly longer than those without resection (median OS: 19 months vs. 8 months, P 60 years based on their age at diagnosis. Race was categorized as white, black, and other (American Indian/AK Native, Asian/Pacific Islander). The primary subsites were classified into four groups (glottic, supraglottic, subglottic, and other), based on Site Recode ICD-O-3/WHO 2008. For all patients in the SEER database, between 2004 and
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European Archives of Oto-Rhino-Laryngology
2015, tumor stages were given according to the 6th American Joint Committee on Cancer (AJCC). It’s scarcely possible for us to translate 6th AJCC edition stages into their corresponding 8th edition stages because the information about both clinical and pathological lymph nodes extracapsular extension was not recorded in the SEER database. For uniform analysis, we collapsed all tumor (T) stages into T0, T1, T2, T3, and T4. For instance, T1a and T1b status in LC were collapsed into T1. In the same way, all nodal (N) stages were also collapsed. According to the ICD-O-3 codes (International Classification of Diseases for Oncology, 3rd Edition), all patients were separated into two pathological categories, i.e., squamous cell carcinoma (SCC), and non-SCC (such as adenocarcinoma or neuroendocrine carcinoma). Only four metastatic sites were specifically recorded in the SEER database for LC patients: bone, brain, liver, and lung. Considering the heterogeneous prognosis and low proportion of bone, brain, and liver metastasis [12], which would hinder the statistical analysis, patients with these confirmed metastatic sites were excluded. And the metastatic sites for DMLC were classified as lung and other (such as soft tissues or mediastinum). The extra exclusion criteria: (1) not the only one malignancy (2) without complete information (race, primary site, surgery, cause of death, and survival months) (3) stages not accessed (TX, NX) (4) received no treatment. In this study, primary tumor resection was defined as tumor-direct surgery on the primary si
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