Trend in Initial Management of T4 Laryngeal Squamous Cell Carcinoma

Background Contemporary initial management trends for locally advanced laryngeal carcinoma remain unclear. This study evaluated whether initial treatment for clinical tumor stage 4a (cT4a) laryngeal cancer has changed over time and associated survival. Methods Retrospective cohort study using the National Cancer Database (NCDB) from 2004 to 2022 of patients with cT4a laryngeal squamous cell carcinoma. Survival outcomes were analyzed with the Mann‐Kendall test, Kaplan–Meier method, logistic regression, Cox‐proportional hazards, and log‐rank tests. Results Among 12 142 cT4a laryngeal cancer patients (81.3% male, mean age 60.9 years), initial surgical management increased from 41.0% in 2004 to 65.3% in 2022. Two‐year overall survival increased from 58.2% (2004) to 70.3% (2021). Upfront surgery was independently associated with higher 2‐year overall survival on multivariable analysis, Kaplan–Meier, and log‐rank testing ( p < 0.001). Conclusion For patients with cT4a laryngeal cancer, management with initial surgery has become more popular and may offer improved overall survival compared to initial nonsurgical management.