Real-world surgical outcomes and prognostic factors in stage III–IVA laryngeal squamous cell carcinoma: a multicenter, retrospective, cohort study in northern Japan

Background This study evaluated oncological outcomes in a multicenter, real-world cohort of patients with stage III and IVA laryngeal squamous cell carcinoma (LASCC) undergoing surgery and identified prognostic factors associated with recurrence and mortality to inform risk-adapted treatment strategies in the era of perioperative pembrolizumab. Methods A total of 381 patients with stage III–IVA LASCC who underwent curative-intent surgery at 13 hospitals in northern Japan were retrospectively analyzed. Clinical, pathological, treatment, and survival data, including disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS), were analyzed according to pretreatment clinical and postoperative pathological factors. Results In the 381 patients, the 3-year DFS, OS, and DSS rates were 64.2%, 85.2%, and 90.0% in stage III disease and 49.5, 75.4, and 78.9% in stage IVA disease, respectively. Multivariate Cox regression analysis showed that increasing age was independently associated with poorer survival in patients with stage III disease. High-risk pathological features (extranodal extension or positive surgical margins) were associated with significantly worse survival. Adjuvant concurrent chemoradiotherapy (CCRT) was infrequently administered, even to high-risk patients. Conclusions Patients with stage III disease demonstrated good outcomes after surgery, with younger age associated with better survival, whereas those with stage IVA disease or high-risk pathological features had worse survival. These findings provide prognostic information to inform risk-adapted perioperative treatment strategies.