Differences in Survival Following Surgery Versus Chemoradiotherapy for Clinical Stage T4a Laryngeal Squamous Cell Carcinoma: A Propensity Score-Matched Analysis

Background: Although laryngeal cancer incidence has declined in the United States, case fatality has risen. The survival equivalence of surgery versus chemoradiotherapy (CRT) for cT4a laryngeal squamous cell carcinoma (LSCC) remains uncertain. Methods: We conducted a retrospective cohort study of cT4a LSCC patients treated with curative-intent surgery or CRT using the National Cancer Database (2010–2021). Those receiving neoadjuvant or palliative therapy, or with distant metastases were excluded. Survival was assessed using Kaplan–Meier and Cox models after 1:1 propensity score matching. Results: Among 3569 patients (mean age 61.0, 708 female), 2437 (68.3%) underwent surgery while 1132 (31.7%) received CRT. In the matched cohort (n = 452 per arm), median survival was 52.8 (95% CI: 45.6–62.4) versus 37.6 (95% CI: 29.2–45.4) months for surgery versus CRT. Adjusted HR for CRT relative to surgery was 1.26 (95% CI: 1.02–1.57). Conclusions: Surgery was associated with improved overall survival compared with definitive CRT in patients with T4a LSCC.