Prognostic Assessment and Risk Stratification of Laryngeal Spindle Cell Carcinoma: A Multicenter Retrospective Study

OBJECTIVE: To compare the clinicopathological features between laryngeal spindle cell carcinoma (LSpCC) and laryngeal squamous cell carcinoma (LSCC), and to develop and validate a prognostic model for LSpCC. STUDY DESIGN: A multicenter, retrospective cohort study. SETTING: This study was conducted at a tertiary referral hospital (West China Hospital) and included data from the SEER database (2009-2022). METHODS: A total of 37 LSpCC patients from West China Hospital and 432 LSpCC cases from the SEER database were included. LSCC patients (1:3 matched) were used as a comparison group. Clinical and demographic variables were analyzed using Kaplan-Meier survival curves and Cox regression models. A prognostic nomogram was developed to predict 1-, 3-, and 5-year overall survival (OS) and was validated using both internal and external cohorts. Model performance was evaluated with calibration plots, time-dependent receiver operating characteristic curves, and decision curve analysis (DCA). RESULTS: LSpCC patients were predominantly male, with an average age of 61.03 years. LSpCC had a significantly worse prognosis than LSCC (P = .043). Cox regression identified age, tumor stage, primary site, and treatment approach as significant prognostic factors for OS. The developed nomogram showed strong predictive accuracy, with AUC values ranging from 0.722 to 0.858 in both internal and external validation cohorts. DCA demonstrated the clinical utility of the model in predicting long-term outcomes. CONCLUSIONS: This study highlights the poor prognosis of LSpCC and provides a validated nomogram for individualized survival predictions. These findings underscore the need for tailored treatment approaches in managing this aggressive cancer subtype.