Additional value of dynamic iodine concentration derived from dual-energy CT in larynx preservation decision following neoadjuvant chemotherapy.

Aim: To develop a larynx preservation (LP) score model to predict laryngectomy-free survival (LFS) in advanced laryngeal squamous-cell carcinoma (LSCC) with morphological response to neoadjuvant chemotherapy (NAC).

Materials And Methods: In this retrospective study, patients with advanced LSCC were included. All patients were classified into NAC response and non-response groups according RECIST. Arterial and venous phases of standardized iodine concentrations of dual-energy CT were measured in the response group, and the rate of iodine concentration change (ΔNIC%) was calculated by (NICpost-NICpre)/NICpre ×100%. Clinical outcomes between the two groups were analyzed using chi-square test. Univariable and multivariable cox regression analyses were performed to evaluate the independent predictors of LFS in the response group. A risk score was developed based on the hazard ratios from the multivariable analysis.

Results: A total of 146 patients were included. 86 patients achieved a response. T stage, N status, and ΔNAIC% were independent predictors of LFS for LSCC patients with NAC morphological response (all, p<0.001). Based on these factors, the established LP risk score model demonstrated an AUC of 0.877 for the 1-year LFS rate and 0.950 for the 2-year LFS rate. Patients with a score ≥6 had a worse LFS (p<0.001) and OS (p=0.001).

Conclusion: A prediction risk score incorporating T stage, N status, and ΔNAIC% shows good predictive effectiveness for LFS in advanced LSCC with morphological response to NAC. It can prevent high-risk patients in the NAC response group from undergoing salvage laryngectomy and improve patient prognosis.