Concurrent chemoradiotherapy vs. total laryngectomy in locally advanced laryngeal squamous cell carcinoma: a propensity score-matched retrospective cohort study.

This study aimed to compare overall survival (OS) and disease-free survival (DFS) between concurrent chemoradiotherapy (CCRT) and total laryngectomy (TL) in patients with locally advanced laryngeal squamous cell carcinoma (LA-LSCC), using propensity score matching (PSM) to adjust for baseline imbalances. A total of 512 patients treated at Harbin Medical University Cancer Hospital between January 2015 and December 2022 were retrospectively analyzed. PSM was performed using 1:1 nearest-neighbor matching with a caliper of 0.2, incorporating age, Eastern Cooperative Oncology Group (ECOG) performance status, T stage, N stage, tumor subsite, vocal cord fixation, thyroid cartilage invasion, and airway obstruction, resulting in 220 matched pairs. Before matching, the TL group had higher proportions of stage IVA disease, vocal cord fixation, and thyroid cartilage invasion; after matching, baseline characteristics were well balanced. Both before and after PSM, TL was associated with significantly improved OS and DFS compared with CCRT. In the matched cohort, median OS and DFS were not reached in the TL group, whereas the CCRT group had a median OS of 49.0 months and a median DFS of 42.5 months (log-rank P < 0.001 for both). Multivariable Cox regression identified CCRT as an independent risk factor for OS (hazard ratio [HR] = 1.819, 95% confidence interval [CI] 1.386-2.386) and DFS (HR = 2.091, 95% CI 1.601-2.732). Subgroup analyses showed inferior outcomes with CCRT in most subgroups, with ECOG performance status and vocal cord involvement acting as significant effect modifiers. Eight sensitivity analyses consistently supported the primary findings (OS: HR range 1.50-1.89; DFS: HR range 1.68-2.13). In conclusion, in this real-world cohort of patients with LA-LSCC, TL was associated with better survival outcomes than CCRT, and treatment decisions should consider T/N stage, ECOG performance status, and vocal cord fixation to enable individualized selection and avoid potential over-preservation of the larynx.