Acta oto-laryngologica · 2026
Refusal of surgery in patients with laryngeal or hypopharyngeal squamous cell carcinoma.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
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Kubo Yoshihito, Tojima Ichiro, Yamazaki Kai, Kawakita Kento, Nishiguchi Tatsuji, Sudo Tomoyuki, Matsumoto Koji, Owaki Shigehiro, Takenaka Yukinori
Аннотация
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.
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.