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Association of Pharyngocutaneous Fistula With Cancer Outcomes in Patients After Laryngectomy
- Source :
- JAMA Otolaryngol Head Neck Surg
- Publication Year :
- 2021
- Publisher :
- American Medical Association (AMA), 2021.
-
Abstract
- Importance Pharyngocutaneous fistula (PCF) results in an inflammatory reaction, but its association with the rate of locoregional and distant control, disease-free survival, and overall survival in laryngeal cancer remains uncertain. Objective To determine if pharyngocutaneous fistula after salvage laryngectomy is associated with locoregional and distant control, disease-free survival, and/or overall survival. Design, Setting, and Participants A multicenter collaborative retrospective cohort study conducted at 5 centers in Canada and the US of 550 patients who underwent salvage laryngectomy for recurrent laryngeal cancer from January 1, 2000, to December 31, 2014. The median follow-up time was 5.7 years (range, 0-18 years). Main Outcomes and Measures Outcomes examined included locoregional and distant control, disease-free survival, and overall survival. Fine and Gray competing risk regression and Cox-proportional hazard regression models were used for outcomes. Competing risks and the Kaplan-Meier methods were used to estimate outcomes at 3 years and 5 years. Results In all, 550 patients (mean [SD] age, 64 [10.4] years; men, 465 [85%]) met inclusion criteria. Pharyngocutaneous fistula occurred in 127 patients (23%). The difference in locoregional control between the group of patients with PCF (75%) and the non–PCF (72%) group was 3% (95% CI, −6% to 12%). The difference in overall survival between the group with PCF (44%) and the non–PCF group (52%) was 8% (95% CI, −2% to 20%). The difference in disease-free survival between PCF and non–PCF groups was 6% (95% CI, −4% to 16%). In the multivariable model, patients with PCF were at a 2-fold higher rate of distant metastases (hazard ratio, 2.00; 95% CI, 1.22 to 3.27). Distant control was reduced in those with PCF, a 13% (95% CI, 3% to 21%) difference in 5-year distant control. Conclusions and Relevance This multicenter retrospective cohort study found that development of PCF after salvage laryngectomy is associated with an increased risk for the development of distant metastases.
- Subjects :
- Adult
Male
medicine.medical_specialty
Cutaneous Fistula
medicine.medical_treatment
Laryngectomy
Pharyngocutaneous Fistula
Postoperative Complications
Internal medicine
Humans
Medicine
In patient
Neoplasm Metastasis
Laryngeal Neoplasms
Original Investigation
Aged
Retrospective Studies
Aged, 80 and over
Salvage Therapy
business.industry
Recurrent laryngeal cancer
Hazard ratio
Cancer
Retrospective cohort study
Pharyngeal Diseases
Middle Aged
medicine.disease
Survival Analysis
Treatment Outcome
Otorhinolaryngology
Female
Surgery
Respiratory Tract Fistula
business
Follow-Up Studies
Cohort study
Subjects
Details
- ISSN :
- 21686181
- Volume :
- 147
- Database :
- OpenAIRE
- Journal :
- JAMA Otolaryngology–Head & Neck Surgery
- Accession number :
- edsair.doi.dedup.....a225028963deddb9febda46f2ffdffe5