{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T09:59:20Z","timestamp":1753869560711,"version":"3.41.2"},"reference-count":30,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1KL2TR001444"],"award-info":[{"award-number":["1KL2TR001444"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Laryngoscope Investig Oto"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective(s)<\/jats:title><jats:p>A subset of laryngeal squamous cell carcinoma (LSCC) patients undergoing larynx preserving treatment ultimately require total laryngectomy (TL) for oncologic or functional reasons. This study aims to identify TL risk factors in these patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Retrospective cohort study using Veterans Affairs (VA) database. T1\u2013T4 LSCC cases treated with primary radiotherapy (XRT) or chemoradiotherapy (CRT) were assessed for TL and recurrence. Binary logistic and Cox regression and Kaplan\u2013Meier analyses were implemented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 5390 cases, 863 (16.0%) underwent TL. On multivariable analysis, age (adjusted odds ratio: 0.97 [0.96\u20130.98]; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and N3 disease (0.42 [0.18\u20131.00]; <jats:italic>p<\/jats:italic>\u2009=\u2009.050) were associated with reduced risk of TL, whereas current alcohol use (1.22 [1.04\u20131.43]; <jats:italic>p<\/jats:italic>\u2009=\u2009.015) and\u2009&gt;T1 disease (T2, 1.76 [1.44\u20132.17]; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001; T3, 2.06 [1.58\u20132.68]; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001; T4, 1.79 [1.26\u20132.53]; <jats:italic>p<\/jats:italic>\u2009=\u2009.001) were associated with increased risk of TL. However, N2 (adjusted hazard ratio: 1.30 [1.10\u20131.55]; <jats:italic>p<\/jats:italic>\u2009=\u2009.003) and N3 (2.02 [1.25\u20133.26]; <jats:italic>p<\/jats:italic>\u2009=\u2009.004) disease were associated with an increased risk for local recurrence. Compared to XRT, treatment with CRT was associated with reduced risk for local recurrence after adjusting for other factors (0.84 [0.70\u20130.99]; <jats:italic>p<\/jats:italic>\u2009=\u2009.044). Those who do not receive TL following local recurrence have poorer disease\u2010specific survival (log\u2010rank, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). In patients without local recurrence, N2 disease was associated with a fourfold increase in risk of TL (4.24 [1.83\u20139.82]; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Advanced nodal stage was associated with reduced rates of salvage TL in the setting of local recurrence, and subsequent worse prognosis after recurrence. Conversely, advanced nodal stage may increase the risk for functional salvage TL in patients without recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>Level 3.<\/jats:p><\/jats:sec>","DOI":"10.1002\/lio2.1317","type":"journal-article","created":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T13:30:53Z","timestamp":1722951053000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with total laryngectomy following organ\u2010preserving treatment of laryngeal <scp>SCC<\/scp>"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5733-7048","authenticated-orcid":false,"given":"Mitchell T.","family":"Victor","sequence":"first","affiliation":[{"name":"University of California San Diego School of Medicine  San Diego California USA"},{"name":"Northwestern University, Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5078-813X","authenticated-orcid":false,"given":"Farhoud","family":"Faraji","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California San Diego Health  La Jolla California USA"},{"name":"Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer Center University of California San Diego Health  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rohith","family":"Voora","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California San Diego Health  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0485-9042","authenticated-orcid":false,"given":"Sandhya","family":"Kalavacherla","sequence":"additional","affiliation":[{"name":"University of California San Diego School of Medicine  San Diego California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loren K.","family":"Mell","sequence":"additional","affiliation":[{"name":"Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer Center University of California San Diego Health  La Jolla California USA"},{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego Health  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brent S.","family":"Rose","sequence":"additional","affiliation":[{"name":"Department of Radiation Medicine and Applied Sciences University of California San Diego Health  La Jolla California USA"},{"name":"Department of Radiation Oncology Veterans Affairs San Diego Healthcare System  San Diego California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1689-3275","authenticated-orcid":false,"given":"Theresa W.","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2010Head and Neck Surgery University of California San Diego Health  La Jolla California USA"},{"name":"Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer Center University of California San Diego Health  La Jolla California 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