Laryngeal Squamous Cell Carcinoma in 4256 Women: A Population-Based Analysis of Gender’s Prognostic Implications

Abstract

Objectives:

1) Describe a large series of female patients with laryngeal squamous cell carcinoma (SCC). 2) Determine if there are gender-related differences in clinicopathologic factors, outcomes, and prognostic indicators.

Methods:

All cases of laryngeal SCC diagnosed between the years 2000-2008 were extracted from the Surveillance Epidemiology and End Results database. Clinicopathologic data, disease-specific survival (DSS), and prognostic factors were compared between genders using chi-square, Kaplan-Meier, and multivariable regression analysis.

Results:

Of 21,666 patients, 4,256 (19.6%) were female. Supraglottic tumors were predominant in females (61%) (vs. 64% glottic tumors in males; P < 0.001); and females with supraglottic SCC were less likely to present with locally-advanced disease or nodal metastases (P < 0.001). Overall, female gender was independently associated with improved DSS (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.74-0.89, P < 0.001). Further analysis stratified by age subgroups revealed that the favorable prognostic implications associated with female gender were limited to patients diagnosed at age<70y (P < 0.005). In this group, females carried a 27-32% lower risk of SCC-specific mortality on multivariable analysis (P < 0.005). Notably, the protective effective of female gender was lost after age at diagnosis exceeded 70y (P > 0.25). Prognostic factors were mostly similar within each gender subgroup; however, the negative prognostic implications of age were significantly greater in females. In fact, the risk of laryngeal SCC-specific death nearly tripled per annum in females (2.9% vs. 1.6% in males, P < 0.01).

Conclusions:

There are significant gender-related clinicopathologic differences in laryngeal SCC. Females diagnosed at age<70y have significantly better DSS than males; and mortality risk is highly attributable to age in women.