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Refusal of surgery in patients with laryngeal or hypopharyngeal squamous cell carcinoma
Yoshihito Kubo1, Ichiro Tojima1, Kai Yamazaki1
1Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science, Otsu, Japan.
Background:
Patients with laryngeal and hypopharyngeal cancers may refuse recommended surgery owing to concerns about voice loss.
Objectives:
To investigate the factors associated with surgery refusal and the survival outcomes of patients who refused surgery.
Patients And Methods:
We obtained data from 24,340 surgery and 1500 refusal cases using the Surveillance, Epidemiology, and End Results database. Overall survival (OS) rates were estimated using the Kaplan-Meier method. Odds ratios for surgery refusal and hazard ratios (HRs) for death were calculated using logistic regression and Cox proportional hazard models.
Results:
Older age, year of diagnosis, advanced disease and marital status were associated with surgery refusal. The five-year OS rate was significantly lower in the refusal group than in the surgery group (27.3% vs. 55.8%, respectively) (p < 0.001). Within the refusal group, patients who refused both surgery and radiation therapy (RT) had a five-year survival rate of 8.9%, whereas those who refused surgery but received RT showed a five-year OS rate of 36.3%. Administration of RT and chemotherapy were independent prognostic factors for OS (HR 0.41 (95%CI 0.35-0.48) and 0.80 (95%CI 0.69-0.91), respectively).
Conclusions:
Although non-surgical treatment remains an alternative option, surgery refusal is associated with poor prognosis.
