Objective: Limited investigation of factors potentially contributing to treatment choice in early-stage glottic carcinoma (EGC) has been performed with large scale data. The National Cancer Database (NCDB) represents ~ 70% of all new cancer cases in the United States. We hypothesized that NCDB variables may lend insight into treatment decisions between surgery and radiation for EGC.
Method: The NCDB was queried for all cases of T1-2N0M0 glottic carcinoma from 2004 - 2016. We used multivariable logistic regression analysis to examine factors associated with first line treatment modality (surgery alone vs radiation alone).
Results: 32,204 EGC patients received treatment: 5,568 (17%) surgery; 19,501 (61%) radiation; and 7,135 (22%) surgery and radiation. Odds ratios (OR) for receiving radiation (versus surgery) alone were > 2 for: more advanced T stage cancers (OR 2.5 [95%CI: 2.3, 2.7], treatment at non-academic facilities (OR 2.5, [95%CI: 2.4, 2.7]), and shorter travel distances to treatment centers (OR 2.1, [95%CI: 2.0, 2.4]). Compared to private insurance, those with Medicaid (OR:1.6 [95%CI: 1.4, 1.9]) or who were uninsured (OR 1.5 [95%CI: 1.2, 1.8]) had greater odds of receiving radiation, after adjusting for gender, education level, region, and facility volume covariates, all p < 0.05. Age, income level, and race were not associated with treatment type.
Conclusion: Most patients in the United States receive first line treatment with radiation for EGC, and this decision is associated with various tumor, patient, and treatment facility factors. These data can serve as a starting point for international comparisons in treatment modalities for EGC.