Beyond tumor staging: Integrative analysis of comorbidity and lifestyle-associated risk factors for surviving advanced head and neck cancer

Introduction:

Comorbidity in patients with head and neck squamous cell carcinoma (HNSCC) influences treatment decision and clinical course. Comprehensive analyses of the impact of localization, other tumor characteristics, comorbidity and lifestyle-associated risk factors on overall survival (OS), tumor-specific survival (TSS) and non-cancer-related death (NCD) are desirable.

Methods:

OS, TSS and NCD of 347 patients with advanced HNSCC of the larynx, hypo- and oropharynx (n = 97/111/139; mean follow-up 42.8, 95% confidence interval 39.2 – 46.4, median 36.4 months) were analyzed using Kaplan-Meier curves (log-rank test) and Cox proportional hazard models (CPHM) in SPSS, evaluating the association between risk factors (smoking, alcohol consumption and age) and comorbidity (assessed by Charlson-Score, CS).

Results:

According to univariate analyses, comorbidity impairs OS and NCD (p = 0.038; p = 0.002), not TSS. Age at diagnosis impacts NCD (p = 0.019), but despite TSS tending to be better in patients aged > 61 years (p = 0.066) did not affect OS (p = 0.748). TSS was predominantly dependent on tumor characteristics (localization, T4-stage, N-stage > 1, UICC IVB) as well as on alcohol consumption > 60 g/d and smoking (all p < 0.02). Multivariate CPHM confirmed alcohol consumption > 60 g/d and tumor characteristics as factors significantly reducing TSS, while NCD depends on age, CS and smoking (all p < 0.03), but not on localization and other tumor characteristics. Multivariate CPHM demonstrated a significant impact of tumor-characteristics, alcohol, age and CS> 0 on OS.

Conclusion:

Comorbidity, alcohol consumption and smoking are independent predictive survival parameters for OS, TSS and NCD, thus their consideration as covariates for stratification in clinical studies is recommended.

Publication History

Publication Date:
18 April 2018 (online)