Abstract: Abstract: Objective To compare the long-term efficacy of surgical and non-surgical comprehensive therapies in the treatment of locally advanced laryngeal cancer (T3-4N0-3M0), and to explore the treatment options for the advanced laryngeal cancer. Methods The clinical data and follow-up data of 190 patients initially diagnosed with locally advanced laryngeal cancer and underwent surgical (total laryngectomy or partial laryngectomy, TL/PL) and non-surgical (chemoradiotherapy or concurrent chemoradiotherapy, CRT/CCRT) treatments in our hospital were enrolled in the study for a retrospective analysis. The 5-year survival results and survival influencing factors in two groups as well as clinical and pathological subgroups were explored and discussed. Results There were 136 patients in the surgical group (TL 100 cases, PL 36 cases) and 54 patients in the non-surgical group (CRT 42 cases and CCRT 12 cases), of which the 5-year overall survival (OS) rates were 50.7% and 33.3% in surgical group and non-surgical group respectively (Log-rank χ2=9.116，P＜0.01). The 5-year progressionfree survival (PFS) rates were 46.3% and 22.2% respectively (Log-rank χ2=13.927，P＜0.01). For patients with T4 tumors, clinical stage Ⅳ, lymph node metastasis and supraglottic laryngeal cancer, the 5-year OS was higher in the surgical group than that in the non-surgical group (P＜0.01). In the non-surgical group, 8 patients with T4b stage died within 5 years. The 5-year OS of 46 patients who effectively responded to the induction chemotherapy was 39.1%, which was not statistically different from that of the surgical group (50.7%, Log-rank χ2=1.855, P＞0.05). Eleven patients underwent salvage TL with a 5-year OS of 45.5%, which was not statistically different from that of the surgical group (Log-rank χ2=0.114, P＞0.05). Moreover, compared with the surgical group, patients of the non-surgical group showed a higher risk of death (HR=2.580, 95%CI: 1.665-3.997, P＜0.01). Multivariate analysis showed that smoking, lymphatic metastasis, clinical stage Ⅳ and tumor recurrence were independent prognostic factors for OS of advanced laryngeal cancer (P＜0.05). Conclusion For locally advanced laryngeal cancer, the long-term efficacy of comprehensive therapy based on surgical treatment is better than that of the non-surgical treatment. Patients who are effective to induction chemotherapy could try non-surgical treatment to preserve laryngeal function. The salvage of total laryngectomy may improve the long-term survival for patients with non-surgical treatment failure.

Key words: laryngeal neoplasms, carcinoma, squamous cell, chemoradiotherapy, adjuvant, laryngectomy, survival
analysis, prognosis, locally advanced laryngeal cancer