Geographic trends in management of early-stage laryngeal cancer

Objectives/Hypothesis The goal of the study was to identify geographic trends in the primary treatment of early-stage glottic cancer. Study Design Retrospective analysis of the United States National Cancer Institute's Surveillance, Epidemiology, and End-Results (SEER) database. Methods Using the most up-to-date November 2014 submission of the SEER database in addition to SEER-18 data files, a cohort was created of stage I to II squamous cell glottic cancer from 2004 to 2012. The treatment groups (radiation and surgery) were compared with respect to several pretreatment covariates including age, race, gender, state where they received treatment, year of diagnosis, and American Joint Committee on Cancer (AJCC) stage. Results In analyzing geographic trends, a statistically significant difference in treatment received by region and state was found (P <.0001.). When examining patient demographics, there was no statistically significant difference in treatment by age (P =.5206), AJCC stage (P =.4922), or year of diagnosis (P =.6593). There was a significant difference in racial distribution by treatment (P =.0038), with patients receiving surgery more likely to be black than patients receiving radiation (12% vs. 10%). In analyzing overall survival (OS), there was no significant difference in OS among the four US treatment regions (P =.2508). Conclusions Geographic factors impact overall treatment of early-stage glottic cancer. In addition, it was determined that race was a factor that correlated to differences in treatment modality. Finally, overall survival across the United States was determined to be significantly better in patients receiving radiation therapy.