Comparative Efficacy of Surgery Followed by Postoperative Radiotherapy/Chemoradiotherapy Versus Definitive Radiotherapy/Chemoradiotherapy Alone in Patients With Locally Advanced Laryngeal Cancer: Survival Outcomes and Prognostic Factors

Objectives Locally advanced laryngeal cancer (LALC) treatment options include surgery followed by postoperative radiotherapy (PORT) or chemoradiotherapy (POCRT) versus non-surgical definitive radiotherapy (RT) or chemoradiotherapy (CRT). Their comparative efficacy remains debated. This study aimed to evaluate survival outcomes and prognostic factors in LALC patients receiving postoperative (PORT/POCRT) versus definitive (RT/CRT) treatment. Methods We retrospectively enrolled 210 LALC patients treated at our hospital (2010–2021). Overall survival (OS) and progression-free survival (PFS) were analyzed. Prognostic factors were identified using multivariate Cox regression. Results Median follow-up was 46 months. Median, 3- and 5-year OS was 70 months, 73.2%, and 57.7%, respectively, while the corresponding PFS was 45 months, 55.8%, and 41.3%. Multivariate analysis identified Karnofsky Performance Status (KPS) score, pathological differentiation, and pretreatment prognostic nutritional index (PNI) as independent risk factors for OS and PFS; second primary cancer and lesion site were independent risk factors for PFS. PORT/POCRT was associated with significantly higher local control and PFS than definitive CRT ( P < 0.05). Both PORT/POCRT and definitive CRT were associated with significantly better OS and PFS than definitive RT alone ( P < 0.05). Conclusion Higher KPS, moderate-to-high differentiation, and higher PNI predict better OS and PFS. Absence of a second primary cancer and presence of a glottic primary tumor predict better PFS. PORT/POCRT was most effective, followed by definitive CRT; definitive RT alone was least effective.