Refusal of surgery in patients with laryngeal or hypopharyngeal squamous cell carcinoma.

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.