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Objective To determine the factors predictive of improved survival among patients with advanced laryngeal cancer. <br><br>Design National hospital-based cancer registry. <br><br>Patients Patients treated with total laryngectomy (TL), radiation therapy alone (RT), or combined chemotherapy and radiation therapy (chemo-RT). <br><br>Results Of the 10 590 patients meeting the initial inclusion criteria, 7019 had appropriate nonmissing values in all study variables and were included in the analysis. Overall, TL was significantly associated with increased likelihood of survival compared with RT or chemo-RT (P<.001). Among patients with stage III cancer, TL and chemo-RT had similar impacts on survival (each showed increased survival compared with RT), whereas TL was associated with significantly greater survival than chemo-RT or RT among patients with stage IV disease (P<.001). Overall survival was also decreased among men, black patients (compared with white patients), and patients with Medicare or Medicaid or those who were uninsured (compared with those with private insurance). <br><br>Conclusions Among patients with the most advanced disease (stage IV), TL was associated with increased survival compared with chemo-RT or RT, whereas both TL and chemo-RT improved survival over RT among patients with stage III cancer. Insurance type and black race also showed significant associations with survival, which may reflect barriers in access to care (P<.001). <br><br><br>