Survival and Recurrence Patterns After Total Laryngectomy in Young Laryngeal Squamous Cell Carcinoma Patients

The prognostic role of age in laryngeal squamous cell carcinoma (LSCC) remains unclear, particularly regarding recurrence after total laryngectomy (TL). This study evaluated the impact of age on LSCC outcomes following TL.

Retrospective single-institution cohort study.

Academic tertiary medical center.

We reviewed LSCC patients who underwent TL between 1999 and 2024 grouped by age at surgery: <45 versus ≥45 years. Overall survival (OS) and disease-free survival (DFS) were assessed using Kaplan-Meier and log-rank tests. Site-specific recurrence was analyzed using cumulative incidence functions with Gray's test. Multivariable competing risk regressions with the Fine-Gray model evaluated the association of age with recurrence.

Among 646 TL patients, 17 were <45 years. Five-year OS was 82.0% for <45 versus 54.3% for ≥45 (P = .023); 5-year DFS was 70.2% versus 42.9% (P = .023). There was no significant difference in overall recurrence between age groups. Competing risk analysis showed no significant difference in cumulative incidence of local, regional, or distant recurrence. In multivariable analysis adjusting for T stage, N stage, laryngectomy indication, and adjuvant therapy, younger age was not independently associated with recurrence (sHR 0.55, 95% CI 0.18-1.63, P = .28).

Younger LSCC TL patients demonstrated improved OS and DFS despite comparable recurrence risk. Age was not independently associated with recurrence, suggesting that improved survival in younger patients does not reflect differences in oncologic control. These findings highlight the importance of distinguishing survival from recurrence outcomes and underscore the need for larger studies evaluating survival differences in younger patients.