Assessing the Applicability of the TALK Score: A Modification for Concurrent Tobacco Use During Treatment

Mason Johnson, James Zachary Porterfield, Alexandra Eva Kejner

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Objective: The previously described TALK score (T-stage, Albumin, Liquor, Karnofsky Performance Status) has been proposed as a method to predict laryngectomy-free survival (LFS) in patients undergoing definitive chemoradiation (CRT). This study assesses its use as well as a modification to include continued tobacco use. Study Design: Retrospective chart review. Setting: Academic institution from 2004 to 2020. Methods: Patients diagnosed with larynx or hypopharynx cancer undergoing CRT were reviewed. Clinically relevant variables were collected (TALK), which were dichotomized per previously set cutoffs. Concurrent tobacco use was evaluated and also dichotomized as 0 or 1. Multivariate analysis was conducted to determine which factors were most predictive of the key outcomes of survival and LFS. Results: A total of 2514 patient charts were evaluated. Patients treated for larynx cancer with primary CRT with complete data were included, ultimately totaling 300. Of these, 78 patients required salvage total laryngectomy (TL). Multivariate analysis demonstrated that LFS was best predicted by tobacco use during treatment (odds ratio [OR] 0.3465, 95% confidence interval [CI] 0.1862-0.6300) and Karnofsky Performance Status (OR 0.1646, 95% CI 0.0673-0.3662). Tobacco use during treatment was also strongly predictive of survival. Excluding T4 tumors, the utilization of tobacco in place of T-stage improved the accuracy of the predictive model in this cohort. Conclusion: Given that a T-stage of 4 is typically treated with total laryngectomy, modification of the TALK score to include tobacco use during treatment (tALK) for patients with T < 4 can be used to improve prediction of 3-year LFS and overall survival.

Original languageEnglish
Pages (from-to)282-288
Number of pages7
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number2
StatePublished - Feb 2022

Bibliographical note

Funding Information:
Funding source: The project described was supported by the NIH National Center for Advancing Translational Sciences through grant UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Publisher Copyright:
© American Academy of Otolaryngology–Head and Neck Surgery Foundation 2021.


  • chemoradiation
  • hypopharyngeal cancer
  • laryngectomy
  • larynx cancer
  • organ preservation
  • smoking

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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