Beyond TNM: Tumor Volume as a Prognostic Marker in Laryngeal Cancer.

OBJECTIVES: The objective of this study is to determine whether radiologic tumor volume adds prognostic value for overall survival (OS) and disease-free survival (DFS) in laryngeal squamous cell carcinoma (LSCC) and to evaluate associations with T stage, nodal status, histologic grade, subsite, and treatment modality. METHODS: Patients with cT2-T4 LSCC treated with curative intent between 2018 and 2024 were included. Tumor volumes derived from CT, MRI, or radiotherapy planning contours were analyzed as continuous and binary variables using a threshold identified by log-rank maximization. Survival was assessed with Kaplan-Meier methods and Cox proportional hazards models. RESULTS: Eighty-eight patients were included (39.8% surgical and 60.2% nonsurgical). Median tumor volume was 3.7 cm3 (range 0.03-51.3 cm3). Volume threshold of 22.498 cm3 was associated with a 3.6-fold increase in mortality (60.0% vs. 16.7%; p < 0.001), with significantly worse OS and DFS in the high-volume group (both p < 0.001). On multivariable analysis, high tumor volume remained independently associated with OS after adjustment for age, T stage, and nodal status (HR = 9.66, 95% CI: 2.56-36.39). Tumor volume correlated with T stage (Spearman ρ = 0.569, p < 0.001), and node-positive tumors were larger than node-negative tumors (median 5.6 cm3 vs. 2.6 cm3; p = 0.017). Supraglottic and transglottic tumors had larger volumes than glottic and higher-grade tumors were associated with larger volumes. Nonsurgical patients had smaller tumors than surgical patients. CONCLUSION: Tumor volume was independently associated with survival outcomes in LSCC and may improve risk stratification beyond TNM classification alone. A threshold of 22.498 cm3 identifies a high-risk subgroup and warrants prospective validation for integration into staging and treatment planning.