Risk factors for thyroid gland invasion in advanced laryngeal cancer: implications for selective thyroidectomy

The prevalence of thyroid gland invasion in advanced-stage laryngeal carcinoma requiring total laryngectomy remains inconsistent across published literature, and consensus guidelines for prophylactic thyroidectomy are lacking, resulting in potential overtreatment. This study aimed to determine the frequency of thyroid invasion and identify independent predictive factors in patients with advanced laryngeal carcinoma undergoing total laryngectomy at a tertiary referral center.

A cross-sectional analytical study was conducted on 139 patients who underwent total laryngectomy with thyroidectomy between 2020 and 2025 at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. Bivariate analyses identified candidate predictors, followed by multivariate logistic regression to determine independent risk factors for histopathologically confirmed thyroid invasion.

Thyroid invasion was histopathologically confirmed in 25 of 139 cases (18%). Bivariate analysis revealed significant associations with diagnosis-to- treatment interval, tracheostomy-to-laryngectomy interval, T stage, thyroid car- tilage invasion, and radiologic evidence of thyroid invasion. Multivariate logistic regression identified two independent predictors: tracheostomy-to-laryngectomy interval > 2 months (aOR 7.40, 95% CI 1.2 - 44.1, p < 0.028) and radiologic thyroid invasion (aOR 55.3, 95% CI 14.3-212.9, p < 0.001).

In this cohort, 82% of patients underwent thyroidectomy without pathologic evidence of invasion. The tracheostomy-to-laryngectomy interval and radiologic thyroid invasion are independent predictors of histopathologic thyroid invasion in advanced laryngeal carcinoma. These findings support the development of more selective, evidence-based criteria for thyroidectomy during total laryngectomy, potentially reducing unnecessary surgical morbidity.