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DOI: 10.1055/s-0038-1640191
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.
No conflict of interest has been declared by the author(s).
Publication History
Publication Date:
18 April 2018 (online)
© 2018. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Georg Thieme Verlag KG
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