Impact of Laryngectomy and Organ-Preserving Therapy on Survival in Laryngeal Cancer Patients: A Study Based on the SEER Database

Objective This study aimed to compare the effects of organ-preserving therapy and laryngectomy on the long-term survival of patients with locally advanced laryngeal cancer and to construct a nomogram model for predicting survival outcomes. Methods Data from diagnosed with stage III or IVA squamous cell carcinoma of the larynx between 2010 and 2022 were extracted from the SEER database. Patients were divided into an organ-preserving therapy group and a surgical group based on their treatment. The Kaplan-Meier method, Cox proportional hazards model, and propensity score matching (PSM) were used for survival analysis and prognostic factor investigation. A nomogram predictive model was constructed based on multivariate analysis results. Results A total of 5467 patients with locally advanced laryngeal cancer were included, with 3994 (58.7%) in the organ-preserving therapy group and 1473 (41.3%) in the surgical group. After PSM matching, the median overall survival (OS) (45 months vs. 25 months) and median cancer-specific survival (CSS) (126 months vs. 44 months) in the surgical group were significantly better than those in the organ-preserving therapy group. Multivariate analysis showed that surgery reduced survival by 46% (OS: HR = 0.537) and 53% (CSS: HR = 0.474). The nomogram model constructed based on multivariate analysis demonstrated good discriminative power, calibration, and clinical applicability in both the training and validation sets. Conclusion For locally advanced laryngeal cancer, laryngectomy provides a significant survival benefit compared to organ-preserving therapy. The nomogram model constructed in this study can effectively predict individualized prognosis, providing a quantitative reference for clinical treatment decisions.