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Orlandi E, Fontana G, Licitra L, Tinelli C, Camarda AM, Grau C, Frank SJ. Comprehensive insights on the underlying potential and advantage of proton therapy over intensity-modulated photon radiation therapy as highlighted in a wide real world data analysis. Radiother Oncol 2024; 193:110122. [PMID: 38309585 DOI: 10.1016/j.radonc.2024.110122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Giulia Fontana
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Lisa Licitra
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; Department of Head & Neck Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; Department of Oncology & Haemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Carmine Tinelli
- CNAO National Center for Oncological Hadrontherapy, Scientific Direction Office, Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Cai Grau
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Steven Jay Frank
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
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Lu D, Zhou X, Sun H, Zeng B, Fu J, Gong J, Liao G, Liang Y, Yang L. Risk of second primary cancer in patients with head and neck squamous cell carcinoma: a systemic review and meta-analysis. Clin Oral Investig 2023; 27:4897-4910. [PMID: 37540282 DOI: 10.1007/s00784-023-05066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/07/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVES Second primary cancer is a common event in patients with head and neck squamous cell carcinoma. However, the incidence and relevant factors vary by studies. We conducted a systematic review and meta-analysis of observational studies to estimate the incidence and relevant risk factors. MATERIALS AND METHODS PubMed and Web of Science were searched for studies published between January 2000 and December 2020 that reported the incidence of SPC in HNSCC patients. Per 1000-person-year incidence and odds ratios were used to estimate the incidence and potential risk factors. Due to the high heterogeneity, random-effects models were used to estimate the incidence and 95% confidence interval. RESULTS Seven thousand seven hundred thirteen articles were identified from the databases, in which 60 studies were included in this meta-analysis. The pooled incidence of the total, synchronous, and metachronous SPC in patients with HNSCC were 29.116 per 1000-person-year, 6.960 per 1000-person-year, and 26.025 per 1000-person-year, respectively. The head and neck region was the most common area where SPC occurred, followed by the lung (7.472 per 1000-person-year) and upper digestive tract (2.696 per 1000-person-year). Smoking, alcohol consumption, betel quid chewing, primary cancer of T1-2, and N0 were risk factors, while HPV infection (OR 0.47, 95% CI 0.30-0.72) was the protective factor. CONCLUSIONS SPC is frequently observed in HNSCC patients and had great impact on the prognosis. The findings could promote a more individualized follow-up strategy for SPC in HNSCC patients. CLINICAL RELEVANCE This systemic review and meta-analysis provide sufficient evidence for the establishment of the follow-up strategy for head and neck squamous cancer patients.
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Affiliation(s)
- Dongheng Lu
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Xinyu Zhou
- Department of Oral & Maxillofacial-Head & Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No 639, Zhizaoju Rd, Shanghai, 200011, China
| | - Huaxiu Sun
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Bin Zeng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Jiarun Fu
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Jianbin Gong
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Guiqing Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China
| | - Yujie Liang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China.
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China.
| | - Le Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, 56Th Lingyuanxi Road, Guangzhou, 510055, Guangdong, China.
- Guangdong Province Key Laboratory of Stomatology, No. 74, 2Nd Zhongshan Road, Guangzhou, 510080, Guangdong, China.
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Zhang DD, Lei M, Wang Y, Zeng PJ, Hong YJ, Cai CF. Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis. JMIR Public Health Surveill 2023; 9:e47579. [PMID: 37642982 PMCID: PMC10498314 DOI: 10.2196/47579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/14/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC. OBJECTIVE We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC. METHODS We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer-specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis. RESULTS We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P<.001), SPCM (sHR 0.400, 95% CI 0.321-0.496; P<.001), and NCCM (sHR 0.460, 95% CI 0.378-0.560; P<.001) than those with HPV-negative disease. The 5-year risk of HNCSM was 26.9% and 10.7% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of SPCM was 12.4% and 4.6% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of NCCM of death was 13.7% and 5.8% in those with HPV-negative and HPV-positive disease, respectively (P<.001). Using the Fine and Gray competing-risks model, our results show that those with HPV-negative tumors had a significantly higher risk of HNCSM (P<.001), SPCM (P<.001), and NCCM (P<.001) than those with HPV-negative tumors. CONCLUSIONS HPV-positive OPSCC has a lower NCSM, SPCM, and NCCM as compared to those with HPV-negative OPSCC. HPV positivity is a favorable prognostic factor in the context of overcoming cancer as well as in terms of reducing the risk of other CODs in OPSCC. Our finding supports the need to tailor patient follow-up based on the HPV status of patients with OPSCC.
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Affiliation(s)
- Dong-Dong Zhang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Min Lei
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yue Wang
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Pei-Ji Zeng
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yong-Jun Hong
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Cheng-Fu Cai
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China
- School of Medicine, Xiamen University, Xiamen, China
- Xiamen Key Laboratory of Otolaryngology Head and Neck Surgery, Xiamen, Xiamen, China
- Department of Otorhinolaryngology, Head and Neck Surgery, Xiamen University, Xiamen, China
- Department of Otolaryngology Head and Neck Surgery, Fujian Medical University, Xiamen, China
- College of Otorhinolaryngology Head and Neck Surgery, Xiamen Haicang Hospital, Xiamen, China
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4
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Abe S, Nozawa H, Sasaki K, Murono K, Emoto S, Yokoyama Y, Matsuzaki H, Nagai Y, Yoshioka Y, Shinagawa T, Sonoda H, Ishihara S. Sarcopenia is Associated With Oncological Prognosis and the Incidence of Secondary Cancer in Patients With Middle/Lower Rectal Cancer. Clin Colorectal Cancer 2023; 22:143-152. [PMID: 36418196 DOI: 10.1016/j.clcc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study evaluated the clinical implications of sarcopenia for patients with rectal cancer according to cancer progression. SUMMARY BACKGROUND DATA The negative impact of body composition on long-term outcome has been demonstrated for various malignancies. METHODS We retrospectively reviewed 708 patients with rectal cancer who underwent curative resection at our institution between 2003 and 2020. Factors contributing to long-term outcomes and the incidence of secondary cancer (ISC) were analyzed. Psoas muscle mass index (PMI) was assessed using preoperative computed tomography. Sarcopenia was defined using the PMI cut-off values for Asian adults (6.36 cm2/m2 for males and 3.92 cm2/m2 for females). RESULTS Sarcopenia was identified in 306 patients (43.2%). Sarcopenia was associated with advanced age, low body mass index, smoking history, and advanced T-stage. Multivariate analysis showed sarcopenia was an independent poor prognostic factor for OS (HR 1.71; P = .0102) and cancer-specific survival (HR 1.64; P = .0490). Patients with sarcopenia had significantly higher mortality due to cancer-related death in stages III and IV, whereas non-rectal cancer-related death, including secondary cancer, was markedly increased in stage 0-II sarcopenic rectal patients. Five-year cumulative ISC in patients with and without sarcopenia was 11.8% and 5.9%, respectively. Multivariate analysis revealed that sarcopenia was an independent predictive factor for ISC (HR 2.05; P = .0063). CONCLUSIONS Sarcopenia helps predict survival outcomes and cause of death according to cancer stage for patients with middle/lower rectal cancer who underwent radical surgery. Furthermore, sarcopenia increased the development of secondary cancer in those patients.
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Affiliation(s)
- Shinya Abe
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Matsuzaki
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuzo Nagai
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yuichiro Yoshioka
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahide Shinagawa
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Jung YS, Lee D, Jung KW, Cho H. Long-term Survivorship and Non-cancer Competing Mortality in Head and Neck Cancer: A Nationwide Population-Based Study in South Korea. Cancer Res Treat 2023; 55:50-60. [PMID: 35698446 PMCID: PMC9873318 DOI: 10.4143/crt.2021.1086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 06/10/2022] [Indexed: 02/04/2023] Open
Abstract
PURPOSE As the survival of head and neck cancer (HNC) improves, survivors increasingly confront non-cancer-related deaths. This nationwide population-based study aimed to investigate non-cancer-related deaths in HNC survivors. MATERIALS AND METHODS Data from the Korean Central Cancer Registry were obtained to characterize causes of death, mortality patterns, and survival in patients with HNC between 2006 and 2016 (n=40,890). Non-cancer-related mortality relative to the general population was evaluated using standardized mortality ratios (SMRs). The 5- and 10-year cause-specific competing risks probabilities of death (cumulative incidence function, CIF) and subdistribution hazards ratios (sHR) from the Fine-Gray models were estimated. RESULTS Comorbidity-related mortality was frequent in older patients, whereas suicide was predominant in younger patients. The risk of suicide was greater in patients with HNC than in the general population (SMR, 3.1; 95% confidence interval [CI], 2.7 to 3.5). The probability of HNC deaths reached a plateau at 5 years (5-year CIF, 33.9%; 10-year CIF, 39.5%), whereas the probability of non-HNC deaths showed a long-term linear increase (5-year, CIF 5.6%; 10-year CIF, 11.9%). Patients who were male (sHR, 1.56; 95% CI, 1.41 to 1.72), diagnosed with early-stage HNC (localized vs. distant: sHR, 1.86; 95% CI, 1.58 to 2.21) and older age (65-74 vs. 0-44: sHR, 6.20; 95% CI, 4.92 to 7.82; ≥ 75 vs. 0-44: sHR, 9.81; 95% CI, 7.76 to 12.39) had an increased risk of non-cancer mortality. CONCLUSION Non-HNC-related deaths continue increasing. HNC survivors are at increased risk of suicide in the younger and comorbidity-related death in the older. Better population-specific surveillance awareness and survivorship plans for HNC survivors are warranted.
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Affiliation(s)
- Yuh-Seog Jung
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea,Department of Otorhinolaryngology Head and Neck Surgery, Center for Thyroid Cancer, Goyang,
Korea,Division of Tumor Immunology, National Cancer Center, Goyang,
Korea
| | - Dahhay Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea
| | - Kyu-Won Jung
- Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang,
Korea
| | - Hyunsoon Cho
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea,Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang,
Korea,Department of Cancer AI and Digital Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang,
Korea
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Viani GA, Faustino AC, Danelichen AFB, Matsuura FK, Neves LVF, Fernandes MH, Fernandes JP. Radiotherapy for locally advanced head and neck cancer in elderly patients: results and prognostic factors a single cohort. ACTA ACUST UNITED AC 2021; 26:12-19. [PMID: 33948297 DOI: 10.5603/rpor.a2021.0002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022]
Abstract
Background The objective of this study was to assess the treatment outcomes and prognostic factors of elderly patients with locally advanced head and neck cancer (LAHNC) undergoing radiotherapy (RT). Materials and methods A retrospective cohort from a single institution, from 2000 to 2015, including patients older than 65 years old with LAHNC (stage III-IVa) treated by RT combined or not with chemotherapy (CRT). Univariate and multivariate analysis (MVA) were performed to identify prognostic factors associated with overall survival (OS), cancer-specific survival (CS), and locoregional control (LRC). A p-value < 0.05 was considered significant. Results 220 patients with LAHNC and > 65 years of age were identified. The median follow-up was 3.8 years, the 3/5 years estimated OS, CS, and LRC rate was 40%/30%, 49%/34%, 76%/45%, respectively. In the univariate analysis, clinical stage (III vs. IVa/b, p = 0.01), tumor stage (T1/2 vs. T3/4, p = 0.035), Karnofsky performance status (KPS, 60-70, p = 0.03) and tumor site (other than vs. hypopharynx, p = 0.0001) were associated with lower OS. Patients with clinical stage (III vs. IVa/b, p = 0.01), tumor stage (T1/2 vs. T3/4, p = 0.015), N stage (N0/1 vs. N2/3, p = 0.04), (KPS 60-70, p = 0.04) and tumor site (other than vs. hypopharynx, p = 0.0001) had worst CS. For the LRC, clinical stage (III vs. IVa/b, p = 0.02), tumor stage (T1/2 vs. T3/4, p = 0.02), treatment type (CRT vs. RT, p = 0.02), RT technique (IMRT vs. 2DRT/3DRT, p = 0.0001), and tumor site (other than vs. hypopharynx, p = 0.02) were significant. In the MVA, KPS maintained significant for OS and CS. For LRC, clinical stage (Iva/b, p = 0.007), tumor stage (T3/4, p = 0.047) and radiotherapy technique other than IMRT (p = 0.0001) were significant. Conclusion The OS, CS, and LRC were associated with several prognostic factors. The clinical performance was the main marker of OS and CS. Chemoradiation should be offered to selected elderly patients using IMRT to improve LRC.
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Affiliation(s)
- Gustavo Arruda Viani
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Alexandre Ciufi Faustino
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | | | - Fernando Kojo Matsuura
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Leonardo Vicente Fay Neves
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Marco Henrique Fernandes
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
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Stromberger C, Yedikat B, Coordes A, Tinhofer I, Kalinauskaite G, Budach V, Zschaeck S, Raguse JD, Kofla G, Heiland M, Stsefanenka A, Beck-Broichsitter B, Dommerich S, Senger C, Beck M. Prognostic Factors Predict Oncological Outcome in Older Patients With Head and Neck Cancer Undergoing Chemoradiation Treatment. Front Oncol 2021; 10:566318. [PMID: 33708616 PMCID: PMC7942196 DOI: 10.3389/fonc.2020.566318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Older patients with head and neck cancer (HNC) represent a challenging group, as frailty and comorbidities need to be considered. This study aimed to evaluate the efficacy and side effects of curative and palliative (chemo) radiation ([C]RT) with regard to basic geriatric screening in older patients. Methods This study included HNC patients aged ≥70 years who were treated with curative or palliative (C)RT. Clinicopathological data including Charlson Comorbidity Index (CCI), Karnofsky performance status (KPS), and treatment data were analyzed as predictors of overall survival (OS). Results A total of 271 patients (median age, 74 years) were enrolled. The majority had UICC stage III/IV (90%) and underwent curative treatment (85.2%). A total of 144 (53.1%) patients received definitive and 87 (32.1%) had adjuvant (C)RT. Overall, 40 patients (14.8%) received palliative (C)RT. Median follow-up duration (curative setting) was 87 months, and the 2- and 5-year OS rates were 57.8 and 35.9%, respectively. Median OS was significantly different for age ≤75 vs. >75 years, CCI <6 vs. ≥6, KPS ≥70 vs. <70%, Tx/T1/T2 vs. T3/T4, and adjuvant vs. definitive (C)RT, respectively. Age 70–75 years (p = 0.004), fewer comorbidities when CCI < 6 (p = 0.014), good KPS ≥ 70% (p = 0.001), and adjuvant (C)RT (p = 0.008) independently predicted longer survival. Palliative RT resulted in a median OS of 4 months. Conclusion Older age, lower KPS, higher CCI, and definitive (C)RT are indicators of worse survival in older patients with HNC treated curatively. Without a comprehensive geriatric assessment in patients aged >75 years, the KPS and CCI can be useful tools to account for “fitness, vulnerability or frailty” to help in treatment decision-making.
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Affiliation(s)
- Carmen Stromberger
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Berna Yedikat
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Annekatrin Coordes
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ingeborg Tinhofer
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) partner site Berlin, Berlin, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK) partner site Berlin, Berlin, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Jan-Dirk Raguse
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Grzegorz Kofla
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Max Heiland
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Aksana Stsefanenka
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Benedicta Beck-Broichsitter
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Steffen Dommerich
- Berlin Institute of Health (BIH), Berlin, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
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Adjei Boakye E, Osazuwa-Peters N, Chen B, Cai M, Tobo BB, Challapalli SD, Buchanan P, Piccirillo JF. Multilevel Associations Between Patient- and Hospital-Level Factors and In-Hospital Mortality Among Hospitalized Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:444-454. [PMID: 32191271 DOI: 10.1001/jamaoto.2020.0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Risk factors for in-hospital mortality of patients with head and neck cancer (HNC) are multilevel. Studies have examined the effect of patient-level characteristics on in-hospital mortality; however, there is a paucity of data on multilevel correlates of in-hospital mortality. Objective To examine the multilevel associations of patient- and hospital-level factors with in-hospital mortality and develop a nomogram to predict the risk of in-hospital mortality among patients diagnosed with HNC. Design, Setting, and Participants This cross-sectional study used the 2008-2013 National Inpatient Sample database. Hospitalized patients 18 years and older diagnosed (both primary and secondary diagnosis) as having HNC using the International Classification of Diseases, Ninth Revision, Clinical Modification codes were included. Analysis began December 2018. Main Outcomes and Measures The primary outcome of interest was in-hospital mortality. A weighted multivariable hierarchical logistic regression model estimated patient- and hospital-level factors associated with in-hospital mortality. Moreover, a multivariable logistic regression analysis was used to build an in-hospital mortality prediction model, presented as a nomogram. Results A total of 85 440 patients (mean [SD] age, 62.2 [13.5] years; 61 281 men [71.1%]) were identified, and 4.2% (n = 3610) died in the hospital. Patient-level risk factors associated with higher odds of in-hospital mortality included age (adjusted odds ratio [aOR], 1.03 per 1-year increase; 95% CI, 1.02-1.03), male sex (aOR, 1.23; 95% CI, 1.12-1.35), higher number of comorbidities (aOR, 1.14; 95% CI, 1.11-1.17), having a metastatic cancer (aOR, 1.49; 95% CI, 1.36- 1.64), having a nonelective admission (aOR, 3.26; 95% CI, 2.83-3.75), and being admitted to the hospital on a weekend (aOR, 1.30; 95% CI, 1.16-1.45). Of the hospital-level factors, admission to a nonteaching hospital (aOR, 1.48; 95% CI, 1.24-1.77) was associated with higher odds of in-hospital mortality. The nomogram showed fair in-hospital mortality discrimination (area under the curve of 72%). Conclusions and Relevance This cross-sectional study found that both patient- and hospital-level factors were associated with in-hospital mortality, and the nomogram estimated with fair accuracy the probability of in-hospital death among patients with HNC. These multilevel factors are critical indicators of survivorship and should thus be considered when planning programs or interventions aimed to improve survival among this unique population.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield.,Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, Springfield
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri.,Saint Louis University Cancer Center, St Louis, Missouri
| | - Betty Chen
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Miao Cai
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri
| | | | - Sai D Challapalli
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, Houston, Texas
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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9
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Characteristics of hospitalized dermatomyositis patients with underlying malignancy: a nationally representative retrospective cohort study. Arch Dermatol Res 2020; 313:473-482. [PMID: 32803354 DOI: 10.1007/s00403-020-02127-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/02/2020] [Accepted: 08/08/2020] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Little is known regarding characteristics of hospitalized dermatomyositis (DM) patients. Understanding the unique characteristics of hospitalized DM patients with underlying malignancy is important in guiding development of specific work-up and treatment algorithms. OBJECTIVES We aim to characterize the inpatient burden of DM patients with malignancy (DM malignancy), determine unique characteristics of DM-malignancy inpatients, and assess trends and predictors of cost of care and length of stay for hospitalized DM-malignancy patients. METHODS Hospitalized DM patients with and without malignancy were characterized and compared using 2009-2015 National Inpatient Sample. Associated malignancies, risk factors for malignancy, and trends/predictors for cost of care and length of stay were evaluated using multivariable models. RESULTS Prevalence of malignancies among hospitalized DM inpatients was 10.9%. Age > 40 years and female sex were significantly associated with increased malignancy risk in DM inpatients. Numerous malignancies were significantly more common in men with DM compared to women, including bronchial, non-Hodgkin's lymphoma, head/neck, bladder, esophageal, kidney, and stomach. The most common malignancies in women with DM were breast and ovarian. Head/neck carcinomas were more common in hospitalized DM patients than previous cohorts evaluating outpatients. Socioeconomic characteristics differed between DM patients with/without malignancy. The presence of underlying malignancy did not affect hospitalization cost, length of stay, or mortality in the hospitalized DM population. The economic burden of hospitalized DM patients is increasing over time. CONCLUSIONS DM inpatients with malignancy display numerous differences compared to DM inpatients without malignancy. Further research characterizing hospitalized DM patients is warranted in order to optimize work-up and treatment guidelines for these patients.
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10
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Sugawara K, Yamashita H, Urabe M, Okumura Y, Yagi K, Aikou S, Seto Y. Poor nutritional status and sarcopenia influences survival outcomes in gastric carcinoma patients undergoing radical surgery. Eur J Surg Oncol 2020; 46:1963-1970. [PMID: 32402508 DOI: 10.1016/j.ejso.2020.04.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/18/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The survival impacts of the prognostic nutritional index (PNI) and sarcopenia have been separately investigated in patients with gastric carcinoma (GC), while the prognostic impact of the combination of them remains to be addressed. METHODS In total, 1166 GC patients undergoing radical gastrectomy were retrospectively reviewed. A new prognostic score (PNIS) was developed based on preoperative PNI and sarcopenia; patients with both low PNI (≤44.8) and sarcopenia were allocated a score of 2, and those with only one or neither of these abnormalities were assigned a score of 1 or 0, respectively. RESULTS A lower PNI was independently associated with sarcopenia (P = 0.007). There were 704 (60.4%), 356 (30.5%) and 106 (9.1%) patients in the PNIS 0, 1 and 2 groups, respectively. A higher PNIS was associated with advanced age (P < 0.001) and a higher incidence of postoperative complications (P = 0.01). Patients with PNIS 2 showed significantly poorer overall survival (OS) than those with PNIS 1 or 0 (5-year OS; 57.8% vs. 79.2% vs. 91.6%, P < 0.001). Multivariate Cox hazards analysis showed PNIS 2 to be a powerful predictor of poor OS (HR 5.73, P < 0.001) in patients with pStage I disease, while not being independently associated with OS in those with pStage II/III disease. Patients with PNIS 2 had a markedly higher prevalence of non-GC-related death than those with scores of 0-1. CONCLUSION The scoring system combining PNI and sarcopenia is useful for predicting survival outcomes, especially non-GC-related death, in patients with early GC, a population with basically good oncological outcomes.
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Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hiroharu Yamashita
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masayuki Urabe
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Yasuhiro Okumura
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yagi
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Susumu Aikou
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Bariatric & Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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11
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O'Sullivan B, Hui Huang S, Keane T, Xu W, Su J, Waldron J, Gullane P, Liu FF, Warde P, Payne D, Tong L, Cummings B. Durable therapeutic gain despite competing mortality in long-term follow-up of a randomized hyperfractionated radiotherapy trial for locally advanced head and neck cancer. Clin Transl Radiat Oncol 2020; 21:69-76. [PMID: 32055717 PMCID: PMC7005479 DOI: 10.1016/j.ctro.2020.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 01/14/2020] [Accepted: 01/22/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose/objectives To examine the therapeutic ratio and mortality profile over time in a radiotherapy randomized trial in stage III-IV larynx/pharynx cancer with long-term follow-up. Materials/methods From 1988 to 1995, 331 cases were randomized to either hyperfractionated (HF) (58 Gy/40 fractions, twice daily) or conventional (CF) (51 Gy/20 fractions, once daily) radiotherapy. Overall survival (OS), locoregional (LRC), distant control (DC), ≥Grade 3 late toxicity (LT), and relative mortality risk profile over time were compared between both arms. Results Median follow-up was 13.6 years. HF had a 10% improved OS at 5-years (40% vs 30%, p = 0.04), but the benefit diminished to 3% at 10-years (21% vs 18%). A trend towards higher LRC with HF remained (5-year: 49% vs 40%; 10-year: 49% vs 39%, p = 0.05). DC rates were unchanged (5-year: 87% vs 85%; 10-year: 87 vs 84%, p = 0.56). LT rates were similar (HF vs CF: 5-year: 9% vs 12%; 10-year: 11% vs 14%, p = 0.27). Multivariable analysis confirmed that HF reduced mortality risk by 31% [HR 0.69 (0.55-0.88), p < 0.01] and locoregional failure risk by 35% [HR 0.65 (0.48-0.89), p < 0.01]. Index cancer mortality (5-year: 46% vs 51%; 10-year: 49% vs 55%) was lower in the HF arm. Competing mortality (mostly smoking-related) was also numerically lower with HF at 5-years (14% vs 19%) but became similar at 10-years (30% vs 28%). Conclusions This trial confirms that HF with augmented total dose has a durable 10% effect size on LRC with comparable LT. OS benefit is evident at 5-years (10%) but relative mortality risk profile changes in longer follow-up.
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Affiliation(s)
- Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Thomas Keane
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Patrick Gullane
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Fei-Fei Liu
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Padraig Warde
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - David Payne
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Li Tong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Bernard Cummings
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Canada
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12
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Zapata I, Alvarez M, Hidalgo R, Pajares B, Garcia-Anaya MJ, Toledo MD, Trigo JM, Lupiañez-Perez Y, Medina JA, Jaime Gomez-Millan J. Causes of death in patients with locally advanced head and neck cancer treated with radiotherapy and systemic therapy. BMC Cancer 2019; 19:1241. [PMID: 31864338 PMCID: PMC6925882 DOI: 10.1186/s12885-019-6427-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 12/03/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the incidence of non-cancer mortalities and prognostic factors associated with competitive causes of death in a homogeneous cohort of patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment. METHODS This study included 284 patients with locally advanced head and neck cancer treated with radiotherapy and systemic treatment between 2005 and 2017. The cumulative incidence of death associated with tumour, second tumours, treatment, side effects and comorbidity was calculated. A Fine and Gray regression model was used to investigate factors associated with cancer and competitive mortality. RESULTS The cumulative incidence of tumoral death at 5 and 10 years were 35 and 47% respectively, whereas the cumulative incidence of competitive mortality were 10 and 12% respectively. In the multivariate analysis, age and comorbidity were independent factors for non-cancer mortality. Patients with a high risk of non-cancer mortality presented a cumulative incidence of 17.3% at 5 years and 18.4% at 10 years. CONCLUSIONS This study demonstrated a high incidence of competing mortality in older patients with comorbidities. Non-cancer deaths should be considered when selecting patients for combination therapies and in the study design ofclinical trials.
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Affiliation(s)
- I Zapata
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - M Alvarez
- Laboratorio de biología molecular del cancer, centro de investigaciones medico-sanitarias (CIMES), Universidad de Málaga, Malaga, Spain.,Instituto de investigación biomédica de Malaga, Campus Teatinos s/n., 29010, Malaga, Spain.,Pathology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - R Hidalgo
- Servicio central de Informatica, Universidad de Malaga, Malaga, Spain
| | - B Pajares
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - M J Garcia-Anaya
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - M D Toledo
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J M Trigo
- Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n, 29010, Malaga, Spain
| | - Y Lupiañez-Perez
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J A Medina
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain
| | - J Jaime Gomez-Millan
- Radiation Oncology Department, Hospital Universitario Virgen de la Victoria, Campus Teatinos s/n., 29010, Malaga, Spain. .,Instituto de investigación biomédica de Malaga, Campus Teatinos s/n., 29010, Malaga, Spain.
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13
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Shepherd SJ, Creber N, Mansour K, Wiesenfeld D, Iseli TA, Amott D. Relationship between age, comorbidities and complications in head and neck cancer patients undergoing curative surgery. ANZ J Surg 2019; 90:851-855. [DOI: 10.1111/ans.15611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 10/30/2019] [Accepted: 11/17/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Sally J. Shepherd
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Nathan Creber
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Kristy Mansour
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - David Wiesenfeld
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Tim A. Iseli
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
| | - Deborah Amott
- Head and Neck Oncology Tumour Stream, Department of SurgeryThe Royal Melbourne Hospital, The University of Melbourne Melbourne Victoria Australia
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14
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Lazzari G, De Cillis MA, Buccoliero G, Silvano G. Competing Morbidities In Advanced Head And Neck Squamous Cell Carcinoma Concurrent Chemoradiotherapy: A Strong Implication Of A Multidisciplinary Team Approach. Cancer Manag Res 2019; 11:9771-9782. [PMID: 31819615 PMCID: PMC6875280 DOI: 10.2147/cmar.s229524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 10/22/2019] [Indexed: 12/11/2022] Open
Abstract
Concurrent chemoradiotherapy (CCRT) is the standard approach for the treatment of locally advanced head and neck squamous cell carcinoma. Despite its undisputed advantages, CCRT is associated with acute and late toxicities, leading to unfavorable implications (eg, unplanned interruptions and noncancer-related mortality). The former prolongs the overall treatment time leading to a detrimental effect on tumor control. The latter consists of several noncancer morbidities arising from treatment-related toxicities, identifying a new pathway in cancer fate. This pathway has been termed noncancer mortality or competing mortality and consists of a series of treatment-competing morbidities, which nullify all therapeutic efforts aimed at curing these patients. The management of patients with head and neck squamous cell carcinoma who experience treatment-related toxicities is complex and requires expertise in oncological treatment as well as supportive care. The optimal management of these patients should start with knowledge regarding the most important competing morbidities developing during all phases of the disease (ie, from diagnosis to follow-up) to minimize treatment interruptions, ensure appropriate psychological support, and achieve the best oncological result. The purpose of the present review is to analyze the most important competing morbidities due to patient’s condition at baseline and CCRT, which could result in noncancer mortality. A multidisciplinary team approach is strongly required in the management of this disease.
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Affiliation(s)
- Grazia Lazzari
- Radiation Oncology Unit, S. Giuseppe Moscati Hospital, Taranto 74100, Italy
| | | | | | - Giovanni Silvano
- Radiation Oncology Unit, S. Giuseppe Moscati Hospital, Taranto 74100, Italy
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15
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Non–lung cancer specific mortality after lobectomy or sublobectomy in patients with stage IA non–small cell lung cancer ≤2 cm: A propensity score analysis. J Surg Oncol 2019; 120:1486-1496. [DOI: 10.1002/jso.25724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/27/2019] [Indexed: 12/25/2022]
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16
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Vitzthum LK, Feng CH, Noticewala S, Hines PJ, Nguyen C, Zakeri K, Sojourner EJ, Shen H, Mell LK. Comparison of Comorbidity and Frailty Indices in Patients With Head and Neck Cancer Using an Online Tool. JCO Clin Cancer Inform 2019; 2:1-9. [PMID: 30652602 DOI: 10.1200/cci.18.00082] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Comorbidity is an independent predictor of mortality and treatment tolerance in head and neck cancer and should be considered with regard to treatment intensification. Multiple previously validated models can be used to evaluate comorbidity and propensity to benefit from intensive treatment, but they have not been directly compared. MATERIALS AND METHODS An online tool was developed and used to calculate the Charlson Comorbidity Index (CCI), Adult Comorbidity Evaluation-27 (ACE-27), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Geriatric 8 (G8), Cancer and Aging Research Group (CARG), and Generalized Competing Event (GCE) scores. To assess interrater variability, five evaluators independently calculated scores on a retrospective cohort of 20 patients. Correlation between models as well as age and performance status were calculated from a cohort of 40 patients. RESULTS The GCE and G8 models had an excellent (intraclass correlation coefficient and Fleiss' kappa ≥ 0.75) degree of interrater agreement. The CCI, ACE-27, CIRS-G, and CARG had a good (intraclass correlation coefficient and Fleiss' kappa 0.6-0.74) degree of interrater agreement. There was statistically significant correlation between models, especially with the CCI, ACE-27, and CIRS-G indices. Increased age was correlated with an increased CCI score and having moderate to severe comorbidity was correlated with the ACE-27 model. Except for the G8 model, the comorbidity indices were not associated with Eastern Cooperative Oncology Group performance status. CONCLUSION We developed an online tool to calculate indices of comorbidity in patients with head and neck cancer with a high degree of reproducibility. Comorbidity is not strongly correlated with performance status and should be independently evaluated in patients.
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Affiliation(s)
- Lucas K Vitzthum
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Christine H Feng
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Sonal Noticewala
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Paul J Hines
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Cammie Nguyen
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Kaveh Zakeri
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Elena J Sojourner
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Hanjie Shen
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
| | - Loren K Mell
- Lucas K. Vitzthum, Christine H. Feng, Sonal Noticewala, Cammie Nguyen, Kaveh Zakeri, Elena J. Sojourner, and Hanjie Shen, University of California San Diego; Loren K. Mell, University of California San Diego; Center for Translational Radiation Medicine and Imaging, La Jolla, CA; and Paul J. Hines, Dose Health, Minneapolis, MN
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17
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Adjei Boakye E, Buchanan P, Hinyard L, Osazuwa-Peters N, Schootman M, Piccirillo JF. Incidence and Risk of Second Primary Malignant Neoplasm After a First Head and Neck Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2019; 144:727-737. [PMID: 30027284 DOI: 10.1001/jamaoto.2018.0993] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Second primary malignant neoplasms (SPMNs) are the leading cause of death in survivors of head and neck squamous cell carcinoma (HNSCC). Recently, human papillomavirus (HPV) has emerged as a risk factor for oropharyngeal squamous cell carcinoma and has different prognosis from classic tobacco/alcohol-associated HNSCC. This suggests that there also may be different risks and burden of SPMNs among patients who's HNSCC were from HPV or tobacco and/or alcohol. Objective To assess SPMN risks and burden in a large US cohort of patients with a first potentially HPV-associated HNSCC vs non-HPV-associated HNSCC. Design, Setting, and Participants In this population-based retrospective cohort study, 109 512 adult patients diagnosed with HNSCC between 2000 and 2014 were identified from the Surveillance, Epidemiology, and End Results registry. Exposures HPV-relatedness based on whether patients' first HNSCC was potentially associated with HPV. Patients were grouped into 2 cohorts: potentially HPV-associated HNSCC, and non-HPV-associated HNSCC. Main Outcomes and Measures The primary outcome was incidence of SPMN (defined as the first subsequent primary cancer occurring at least 2 months after first cancer diagnosis). Excess SPMN risk was calculated using relative (standardized incidence ratios [SIRs]) and absolute (excess absolute risk [EAR] per 10 000 person-years at risk [PYR]). Results A total of 109 512 patients with HNSCC (mean [SD] age, 61.9 [12.1] years; 83 305 [76.1%] men) were identified. The overall SIR was 2.18 (95% CI, 2.14-2.22) corresponding to 160 excess cases per 10 000 PYR. The risk among patients with first potentially HPV-associated HNSCC (SIR, 1.98; EAR, 114 excess cases per 10 000 PYR) was lower than those with first non-HPV-associated HNSCC (SIR, 2.28; EAR, 188 excess cases per 10 000 PYR). Overall, the largest SIRs and EARs were observed for cancers of the head and neck, lung, and esophagus. However, the risks of SPMN were lower among potentially HPV-associated HNSCC patients. Conclusions and Relevance Patients diagnosed with HNSCC experience excess risk of SPMN, which was higher among those with non-HPV-associated HNSCC than from potentially HPV-associated HNSCC. Clinicians should implement strategies that prevent or detect SPMN early in patients with HNSCC.
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Affiliation(s)
- Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St Louis, Missouri
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St Louis, Missouri
| | - Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri.,Saint Louis University Cancer Center, St Louis, Missouri.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri
| | - Mario Schootman
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri.,Editor
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18
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Mell LK, Shen H, Nguyen-Tân PF, Rosenthal DI, Zakeri K, Vitzthum LK, Frank SJ, Schiff PB, Trotti AM, Bonner JA, Jones CU, Yom SS, Thorstad WL, Wong SJ, Shenouda G, Ridge JA, Zhang QE, Le QT. Nomogram to Predict the Benefit of Intensive Treatment for Locoregionally Advanced Head and Neck Cancer. Clin Cancer Res 2019; 25:7078-7088. [PMID: 31420360 DOI: 10.1158/1078-0432.ccr-19-1832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/09/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Previous studies indicate that the benefit of therapy depends on patients' risk for cancer recurrence relative to noncancer mortality (ω ratio). We sought to test the hypothesis that patients with head and neck cancer (HNC) with a higher ω ratio selectively benefit from intensive therapy. EXPERIMENTAL DESIGN We analyzed 2,688 patients with stage III-IVB HNC undergoing primary radiotherapy (RT) with or without systemic therapy on three phase III trials (RTOG 9003, RTOG 0129, and RTOG 0522). We used generalized competing event regression to stratify patients according to ω ratio and compared the effectiveness of intensive therapy as a function of predicted ω ratio (i.e., ω score). Intensive therapy was defined as treatment on an experimental arm with altered fractionation and/or multiagent concurrent systemic therapy. A nomogram was developed to predict patients' ω score on the basis of tumor, demographic, and health factors. Analysis was by intention to treat. RESULTS Decreasing age, improved performance status, higher body mass index, node-positive status, P16-negative status, and oral cavity primary predicted a higher ω ratio. Patients with ω score ≥0.80 were more likely to benefit from intensive treatment [5-year overall survival (OS), 70.0% vs. 56.6%; HR of 0.73, 95% confidence interval (CI): 0.57-0.94; P = 0.016] than those with ω score <0.80 (5-year OS, 46.7% vs. 45.3%; HR of 1.02, 95% CI: 0.92-1.14; P = 0.69; P = 0.019 for interaction). In contrast, the effectiveness of intensive therapy did not depend on risk of progression. CONCLUSIONS Patients with HNC with a higher ω score selectively benefit from intensive treatment. A nomogram was developed to help select patients for intensive therapy.
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Affiliation(s)
- Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
| | - Hanjie Shen
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Phuc Felix Nguyen-Tân
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kaveh Zakeri
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Lucas K Vitzthum
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter B Schiff
- Department of Radiation Oncology, New York University School of Medicine, New York, New York
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - James A Bonner
- Department of Radiation Oncology, Hazelrig-Salter Radiation Oncology Center, The University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Stuart J Wong
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - George Shenouda
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Qiang E Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
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19
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Adjei Boakye E, Buchanan P, Hinyard L, Stamatakis K, Osazuwa-Peters N, Simpson MC, Schootman M, Piccirillo JF. Risk and outcomes for second primary human papillomavirus-related and -unrelated head and neck malignancy. Laryngoscope 2018; 129:1828-1835. [PMID: 30582167 DOI: 10.1002/lary.27634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/12/2018] [Accepted: 10/03/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To 1) examine the characteristics of patients who develop second primary malignancies (SPMs) from an index human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) and HPV-unrelated HNSCC and to 2) compare overall survival between those with HPV-related and HPV-unrelated index HNSCC among patients who develop SPM. STUDY DESIGN Retrospective cohort analysis. METHODS A retrospective study was conducted of 113,259 patients who were diagnosed with HNSCC from 2000 to 2014. SPM was defined as the first subsequent primary cancer occurring at least 2 months after index cancer diagnosis, and HPV-relatedness was based on whether patients' index HNSCC was potentially HPV-related or HPV-unrelated. Multivariable Fine and Gray (FG) competing-risks regression models were used to estimate factors associated with risk of SPM by HPV-relatedness. Among patients with SPM, an adjusted Cox proportional hazards (PH) regression model was used to assess the association between HPV-relatedness and survival. RESULTS Approximately 13,900 patients (12.3%) developed SPM. In the FG model, patients with HPV-unrelated HNSCC had a 15% higher risk of developing SPM (adjusted hazard ratio: 1.15, 95% confidence interval: 1.10-1.20) than those with potentially HPV-related HNSCC, but the same characteristics were associated with SPM development. In the Cox PH model, patients with SPM whose index HNSCC was HPV-unrelated had higher risk of death than those whose index HNSCC was potentially HPV-related (adjusted hazard ratio: 1.06; 95% confidence interval: 1.02-1.11). CONCLUSIONS Patients with HPV-unrelated HNSCC have a higher risk of SPM development than do those with HPV-related HNSCC. Effective secondary disease-prevention strategies should be established to improve long-term patient outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 129:1828-1835, 2019.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois.,Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | - Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research, St. Louis, Missouri
| | - Katie Stamatakis
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri.,Saint Louis University Cancer Center, St. Louis, Missouri.,Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mario Schootman
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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20
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Lop J, García J, López M, Taberna M, Mena M, Alemany L, Quer M, León X. Competing mortality in oropharyngeal carcinoma according to human papillomavirus status. Head Neck 2018; 41:1328-1334. [PMID: 30549389 DOI: 10.1002/hed.25559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 08/24/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human papillomavirus (HPV) status. METHODS We studied retrospectively 423 patients with OPC with known HPV status. Among the patients included in the study, 53 (12.5%) were HPV-positive. We analyzed overall survival and competing causes of mortality according to the HPV status of the patients. RESULTS Patients with HPV-negative tumors had lower OPC cancer-specific survival (P = .0001), second primary neoplasm survival (P = .0001), and noncancer-related causes survival (P = .13) than patients with HPV-positive tumors. This resulted in significant differences in overall survival depending on HPV status (P = .0001). CONCLUSION Conclusion: HPV-positive OPC has a better overall survival than HPV-negative OPC. Patients with HPV-positive tumors presented a significant lower OPC cancer-specific and second primary neoplasm mortality and a marginally nonsignificant lower noncancer mortality as compared to HPV-negative tumors.
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Affiliation(s)
- Joan Lop
- Otorhinolaryngology Department, Hospital Parc Taulí, Universitat Autònonoma de Barcelona, Sabadell, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Marisa Mena
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Laia Alemany
- Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO), Institut d'Investigació Biomédica de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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21
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Ye Y, Otahal P, Marwick TH, Wills KE, Neil AL, Venn AJ. Cardiovascular and other competing causes of death among patients with cancer from 2006 to 2015: An Australian population-based study. Cancer 2018; 125:442-452. [PMID: 30311655 DOI: 10.1002/cncr.31806] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/15/2018] [Accepted: 09/21/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND With improved cancer survivorship, cardiovascular disease (CVD) and other noncancer events compete with cancer as the underlying cause of death, but the risks of mortality in competing-risk settings have not been well characterized. METHODS The authors identified 21,637 individuals who had a first cancer registered between 2006 and 2013, with follow-up to 2015, in the Australian population-based Tasmanian Cancer Registry. The cumulative incidence of deaths from specific competing events was assessed in competing-risk analyses. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) for deaths from noncancer causes were calculated for comparison with the general population. RESULTS Overall, 8844 deaths were observed, with 1946 (22%) from competing events. The cumulative incidence of deaths from CVD increased significantly with age at first cancer diagnosis and exceeded other competing events at age ≥65 years. The risk of death from CVD was more common than expected in the first year of follow-up (SMR, 1.44 [95% confidence interval, 1.26-1.64]; AER, 36.8 per 10,000 person-years). The SMR and AER for CVD deaths varied by first cancer site, indicating increased risks after a first diagnosis of lung cancer, hematologic malignancy, and urinary tract cancer. For other noncancer events, the SMRs increased significantly for deaths from infectious disease and respiratory disease and were highest in the first year of follow-up. CONCLUSIONS CVD was the leading cause of competing mortality among Tasmanian patients with cancer who were diagnosed from 2006 to 2013. The higher than expected occurrence of death from CVD and other noncancer events during the first year after a cancer diagnosis highlights the importance of early preventive interventions.
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Affiliation(s)
- Yuanzi Ye
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Department of Pathology, Anhui Medical University, Hefei, Anhui Province, China
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Karen E Wills
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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22
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Kim YH, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Risk factors for competing non-cancer mortality after definitive treatment for advanced-stage head and neck cancer. Oral Dis 2018; 24:1217-1225. [PMID: 29804327 DOI: 10.1111/odi.12904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Patients with head and neck cancer (HNC) can die of index tumor progression and second tumor or non-cancer causes. Here, we investigated the risk factors for competing non-cancer mortality (NCM) in a prospective cohort of patients with advanced-stage HNC. MATERIALS AND METHODS A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced-stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality (CM) defined as death from non-cancer causes and HNC or second cancers, respectively. Cumulative incidence and cause-specific hazard functions were used to analyze the risk factors of NCM and CM. RESULTS Age, smoking, Charlson comorbidity index (CCI), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all p < 0.05). Multivariate analyses showed that age, CCI, and hemoglobin were independent factors of NCM. Age (≥65 years), CCI (≥2), and hemoglobin (<11 g/dl) were related to 4.5-, 3.2-, and 2.7-fold increased adjusted risk of NCM, respectively. CONCLUSIONS Old age, comorbidity, and hemoglobin at diagnosis were independent predictors of NCM. The risk factors could be used to predict non-cancer death after definitive treatment for advanced-stage HNC.
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Affiliation(s)
- Yong Han Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Bae Kim
- Department of Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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23
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Ye Y, Otahal P, Wills KE, Neil AL, Venn AJ. Temporal trends in competing mortality from second and subsequent primary cancers, 1980-2014: An Australian population-based study. Cancer Epidemiol 2018; 55:61-67. [PMID: 29803142 DOI: 10.1016/j.canep.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/20/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Subsequent primary cancers (SPCs) compete with first cancers and non-cancer events as the primary cause of death among cancer patients. We aimed to assess temporal trends in SPC mortality since 1980 among adult-onset cancer patients in competing risk models. METHODS Patients registered with a first cancer in the population-based Tasmanian Cancer Registry, Australia, between 1980-2009 were followed up to December 2014. Cumulative incidence function (CIF) was used to estimate the cumulative incidence of cause-specific deaths in the presence of competing risks. The hazard ratios of SPC-specific deaths were assessed in two regression models: subdistribution hazard ratios from competing risk models (SHRs) and hazard ratios from Cox models (CHRs). RESULTS Overall, 5339 (9.3%) of 57,288 patients developed SPCs and 2494 died from SPCs during the follow-up. While the cumulative incidence of first cancer deaths at 5, 10, 15 and 20-years gradually decreased over periods of first cancer diagnosis, the cumulative incidence of SPC deaths did not. The SHRs for SPC-specific deaths increased from the reference period 1980-1984 to a peak for first cancers diagnosed in 1995-1999 (SHR = 1.18, 95%CI 1.03-1.35), before a decrease in 2005-2009 (SHR = 0.82, 95%CI 0.70-0.95) in competing risk models. However, this pattern was not consistent in CHRs. For individuals with specific first cancers, those with a first prostate cancer in 1995-1999 ha d the greatest SPC mortality risk (SHR = 2.08, 95%CI 1.29-3.36). CONCLUSION Competing risk models, but not Cox models, demonstrated temporal increases in SPC-specific mortality. Greater detection of non-fatal first prostate cancers appears to have contributed to this trend.
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Affiliation(s)
- Yuanzi Ye
- Menzies Institute for Medical Research, University of Tasmania, Australia; Department of Pathology, Anhui Medical University, China
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Karen E Wills
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Australia.
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24
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Mulcahy CF, Mohamed ASR, Kanwar A, Hutcheson KA, Ghosh A, Vock D, Weber RS, Lai SY, Gunn GB, Zafereo M, Morrison WH, Ferrarotto R, Garden AS, Rosenthal DI, Fuller CD. Age-adjusted comorbidity and survival in locally advanced laryngeal cancer. Head Neck 2018; 40:2060-2069. [PMID: 29756307 DOI: 10.1002/hed.25200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 02/19/2018] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to quantify the relationship among age, pretreatment comorbidity, and survival outcomes in patients with locally advanced laryngeal cancer. METHODS Baseline comorbidity data were collected and age-adjusted Charlson Comorbidity Index (CCI) was calculated for each case. Kaplan-Meier and Cox proportional hazards modeling were used to determine associations with survival. RESULTS For 548 patients, with a median age of 59 years (range 31-91 years), 58% were treated with larynx preservation and the rest with total laryngectomy and adjuvant radiotherapy (RT). Two hundred thirty-eight patients (43%) had at least 1 comorbidity each. Cardiovascular diseases were the most common comorbidities (19%). The 5-year overall survival (OS) for patients with CCI ≤3 (n = 442) were superior to CCI >3 (n = 106; 60% vs 41%; P < .0001), although the 5-year disease-specific survival (DSS) rates were not significantly different. The 5-year noncancer CSS was better for age-adjusted CCI ≤3 (88% vs 67%; P < .0001). CONCLUSION The age-adjusted CCI is a significant predictor of noncancer CSS and OS for patients with locally advanced laryngeal cancer but is not associated with DSS.
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Affiliation(s)
| | - Collin F Mulcahy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.,MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Aasheesh Kanwar
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alokananda Ghosh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Vock
- Department of Biostatistics, University of Minnesota of Public Health, Minneapolis, Minnesota
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gary Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renata Ferrarotto
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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25
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Cause-specific mortality in patients with head and neck cancer: Long-term follow-up of a population-based cohort from 1986 to 2012 accounting for competing risks. Oral Oncol 2018; 79:20-26. [DOI: 10.1016/j.oraloncology.2018.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/05/2018] [Accepted: 02/09/2018] [Indexed: 12/21/2022]
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26
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Massa ST, Cass LM, Osazuwa-Peters N, Christopher KM, Walker RJ, Varvares MA. Decreased cancer-independent life expectancy in the head and neck cancer population. Head Neck 2017. [PMID: 28640483 DOI: 10.1002/hed.24850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Aside from cancer mortality, patients with head and neck cancer have increased mortality risk. Identifying patients with the greatest loss of cancer-independent life expectancy can guide comprehensive survivorship programs. METHODS Age-based survival data from the Surveillance, Epidemiology, and End Result (SEER) database for patients with head and neck cancer were censored for mortality from the index cancer. Life expectancy and years of life lost (YLL) referenced to the general population were calculated. Cox proportional regression models produced hazard ratios (HRs). RESULTS Cancer-independent life expectancy for patients with head and neck cancer is 6.5 years shorter than expected. The greatest hazard and impact of other-cause mortality was associated with black race (HR 1.23; YLL 8.55), stage IV (HR 1.60; YLL 7.92), Medicaid (HR 1.55; YLL 12.9), and previous marriage (HR 1.49; YLL 11.4). CONCLUSION Patients with head and neck cancer lives are foreshortened independent of their cancer diagnosis necessitating management of noncancer mortality to maximize overall survival.
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Affiliation(s)
- Sean T Massa
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Lauren M Cass
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Kara M Christopher
- Cancer Center, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Ronald J Walker
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Mark A Varvares
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
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27
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Kwon M, Kim RB, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. Prevalence and clinical significance of cancer cachexia based on time from treatment in advanced-stage head and neck squamous cell carcinoma. Head Neck 2016; 39:716-723. [PMID: 28000343 DOI: 10.1002/hed.24672] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/01/2016] [Accepted: 11/04/2016] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify the prevalence of cancer cachexia and its prognostic impact in patients with advanced head and neck squamous cell carcinoma (HNSCC). METHODS The prevalence of cancer cachexia was analyzed according to the follow-up periods during the first year after curative initial treatment. Recurrences, noncancer health events (NCHEs), and cause-specific survival outcomes were also analyzed according to the incidence of cancer cachexia during follow-up. RESULTS Cancer cachexia was identified in 22 (6.1%), 148 (41%), 66 (18.4%), and 65 (18.7%) of 361 enrolled patients at pretreatment, immediately after treatment, 6-months after treatment, and 12-months after treatment, respectively. Sustained or newly developed cachexia at 6 and 12 months showed a significant association with recurrence and NCHE occurrence (p < .05). In cause-specific survival analysis, patients with cachexia had a higher probability of cancer-specific death, noncancerous death, and overall death (p < .05). CONCLUSION Cachexia prevalence at 6 and 12 months after treatment for HNSCC indicates a higher chance of recurrence, NCHE, and death. © 2016 Wiley Periodicals, Inc. Head Neck 39: 716-723, 2017.
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Affiliation(s)
- Minsu Kwon
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Rock Bum Kim
- Department of Preventive Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinjoo, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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28
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Massa ST, Osazuwa-Peters N, Christopher KM, Arnold LD, Schootman M, Walker RJ, Varvares MA. Competing causes of death in the head and neck cancer population. Oral Oncol 2016; 65:8-15. [PMID: 28109473 DOI: 10.1016/j.oraloncology.2016.12.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/22/2016] [Accepted: 12/07/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE/OBJECTIVES The increasing survivorship of head and neck squamous cell carcinoma (HNSCC) comes with a risk of death from other causes, known as competing causes. The demographics of HNSCC are also evolving with increasing incidence of Human Papillomavirus (HPV) associated tumors. This study describes competing causes of death for the HNSCC population compared to the general population and identifies associated risk factors. METHODS Adult patients with first mucosal HNSCC (2004-2011) were identified from the Surveillance, Epidemiology and End Result database. Competing causes of death were compared to reference populations using proportion of deaths and Standardized Mortality Ratios (SMR). A multivariable competing risk survival analysis yielded subdistribution hazard ratios (HR) for competing mortality. RESULTS Of 64,598 HNSCC patients, 24,602 (38.1%) were deceased including 7142 deaths (29.0%) from competing causes. The most common were cardiovascular disease, lung cancer, and other cancers. All relative mortality rates were elevated, especially liver disease (SMR 38.7; 95% CI: 29.4-49.3), suicide (SMR 37.1; 95% CI: 26.1-48.6), and subsequent primary cancers (SMR 7.5; 95% CI: 6.78-8.32). Demographic and tumor factors independently increased risk of competing mortality, including age (HR per 5years 1.24; 95% CI: 1.22-1.25), sex (male HR 1.23; 95% CI: 1.16-1.32), race (Black HR 1.17; 95% CI: 1.09-1.26), insurance (uninsured HR 1.28; 95% CI: 1.09-1.50), and marital status (single HR 1.29; 95% CI: 1.21-1.37). CONCLUSION Nearly one in three HNSCC patients died from competing causes. When developing long term survivorship regimens for HNSCC patients, clinicians should be familiar with this population's specific risks.
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Affiliation(s)
- Sean T Massa
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States.
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Kara M Christopher
- Cancer Center, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Lauren D Arnold
- College for Public Health and Social Justice, Department of Epidemiology, Saint Louis University, St. Louis, MO, United States
| | - Mario Schootman
- College for Public Health and Social Justice, Department of Epidemiology, Saint Louis University, St. Louis, MO, United States
| | - Ronald J Walker
- Department of Otolaryngology - Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, MO, United States
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States
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Kuo P, Mehra S, Sosa JA, Roman SA, Husain ZA, Burtness BA, Tate JP, Yarbrough WG, Judson BL. Proposing prognostic thresholds for lymph node yield in clinically lymph node-negative and lymph node-positive cancers of the oral cavity. Cancer 2016; 122:3624-3631. [DOI: 10.1002/cncr.30227] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/01/2016] [Accepted: 07/05/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Phoebe Kuo
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
| | - Saral Mehra
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
| | - Julie A. Sosa
- Department of Surgery; Endocrine Surgery, Duke University School of Medicine; Durham North Carolina
- Duke Clinical Research Institute; Durham North Carolina
- Duke Cancer Institute; Durham North Carolina
| | - Sanziana A. Roman
- Department of Surgery; Endocrine Surgery, Duke University School of Medicine; Durham North Carolina
| | - Zain A. Husain
- Yale Cancer Center; New Haven Connecticut
- Department of Therapeutic Radiology; Yale School of Medicine; New Haven Connecticut
| | - Barbara A. Burtness
- Yale Cancer Center; New Haven Connecticut
- Department of Medicine; Yale School of Medicine; New Haven Connecticut
| | - Janet P. Tate
- Department of Internal Medicine; Veterans Affairs Connecticut Healthcare System; West Haven Connecticut
| | - Wendell G. Yarbrough
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
- Department of Pathology; Yale School of Medicine; New Haven Connecticut
| | - Benjamin L. Judson
- Department of Surgery; Otolaryngology, Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
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Kwon M, Kim SA, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY. An Introduction to a Head and Neck Cancer-Specific Frailty Index and Its Clinical Implications in Elderly Patients: A Prospective Observational Study Focusing on Respiratory and Swallowing Functions. Oncologist 2016; 21:1091-8. [PMID: 27368883 DOI: 10.1634/theoncologist.2016-0008] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/18/2016] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Frailty refers to a decreased physiologic reserve in geriatric patients and its importance in terms of treatment planning and outcome prediction has been emphasized in oncologic practices for older patients with cancer. We investigated the clinical implications of a head and neck cancer (HNC)-specific frailty index suggested by prospective clinical and functional evaluations of HNC patients. MATERIALS AND METHODS We analyzed data on 165 elderly patients with HNC who were prospectively enrolled in our hospital from 2010 to 2013. Pretreatment functional evaluations were performed according to all comprehensive geriatric assessment (CGA) domains. We additionally evaluated the patients' respiratory and swallowing functions using pulmonary function tests, voice handicap index (VHI), MD Anderson Dysphagia Inventory (MDADI), and other associated tests. Factors affecting the 2-year morbidity and mortality were also analyzed. RESULTS Respiratory and swallowing problems were major causes of 2-year morbidity. Pretreatment performance status, VHI ≥8, MDADI <70, dental problems, and chemotherapy were significantly associated with early morbidity and mortality (all p < .05). CGA-assessed frailty was found in 72 patients (43.6%) and was significantly associated with 2-year mortality (p = .027) but not with morbidity (p = .716). The high-risk group according to our new HNC-specific frailty index that included functional evaluations of respiration and swallowing showed significantly higher 2-year morbidity (p = .043) and mortality (p < .001). CONCLUSION Pretreatment functional disabilities related to respiration and swallowing were significantly associated with early morbidity and mortality. The suggested index would be more useful for assessing frailty in elderly HNC patients. IMPLICATIONS FOR PRACTICE This study is the first report in terms of suggesting a new frailty index focusing on respiratory and swallowing functions in elderly patients with head and neck cancer. This study shows that functional disabilities associated with respiration and swallowing significantly affected early morbidity and mortality in these elderly patients. The head and neck cancer-specific frailty index described in this report, which includes functional evaluations of respiration and swallowing, significantly predicted both early morbidity and mortality.
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Affiliation(s)
- Minsu Kwon
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Republic of Korea
| | - Shin-Ae Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kang HS, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Noncancer-Related Health Events and Mortality in Head and Neck Cancer Patients After Definitive Radiotherapy: A Prospective Study. Medicine (Baltimore) 2016; 95:e3403. [PMID: 27175640 PMCID: PMC4902482 DOI: 10.1097/md.0000000000003403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected not only by progression of the original cancer or occurrence of a second cancer but also by noncancer health event (NCHE). In this study, we evaluated the prognostic significance of early NCHEs in HNSCC patients after definitive radiotherapy (RT) or chemoradiotherapy (CRT).The prospective study cohort comprised 190 HNSCC patients who underwent definitive RT (n = 75) or CRT (n = 115). An early NCHE was defined as an event requiring hospital readmission of the patient within 12 months after treatment. Univariate and multivariate analyses were performed to identify clinicopathologic factors associated with early NCHEs, and competing and all-cause mortalities.Thirty-three patients suffered an NCHE (17.3%) and 8 succumbed to a competing cause of mortality (4.2%). Twenty-two (11.6%) patients had an early NCHE: respiratory (22.8%), cerebrovascular (13.7%), gastrointestinal (13.7%), and others (50.0%). In multivariate analysis, hypoalbuminemia (P = 0.022, hazard ratio [HR] = 3.66, 95% confidence interval [CI] = 1.21-11.1), chemotherapy (P = 0.047, HR = 3.02, 95% CI = 1.01-8.98), and tumor recurrence (P = 0.024, HR = 2.66, 95% CI = 1.14-6.22) were independent predictors of an early NCHE. Patients with early NCHEs were at high risk of competing mortality (P < 0.001, HR = 22.6, 95% CI = 4.21-121.00) and all-cause mortality (P = 0.002, HR = 4.44, 95% CI = 1.76-11.2).Early NCHEs are a major contributor to competing and all-cause mortality in HNSCC patients receiving RT or CRT. The risk factors identified could be used to predict early NCHEs.
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Affiliation(s)
- Ho-Seob Kang
- From the Departments of Otolaryngology (H-SK, J-LR, S-HC, SYN, SYK); Radiation Oncology; and Internal Medicine (Oncology) (S-BK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Kuo P, Sosa JA, Burtness BA, Husain ZA, Mehra S, Roman SA, Yarbrough WG, Judson BL. Treatment trends and survival effects of chemotherapy for hypopharyngeal cancer: Analysis of the National Cancer Data Base. Cancer 2016; 122:1853-60. [DOI: 10.1002/cncr.29962] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/12/2015] [Accepted: 01/07/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Phoebe Kuo
- Division of Otolaryngology, Department of Surgery; Yale School of Medicine; New Haven Connecticut
| | - Julie A. Sosa
- Division of Endocrine Surgery, Department of Surgery; Duke University School of Medicine; Durham North Carolina
- Duke Clinical Research Institute; Durham North Carolina
- Duke Cancer Institute; Durham North Carolina
| | - Barbara A. Burtness
- Yale Cancer Center; New Haven Connecticut
- Department of Medicine; Yale School of Medicine; New Haven Connecticut
| | - Zain A. Husain
- Yale Cancer Center; New Haven Connecticut
- Department of Therapeutic Radiology; Yale School of Medicine; New Haven Connecticut
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery; Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
| | - Sanziana A. Roman
- Division of Endocrine Surgery, Department of Surgery; Duke University School of Medicine; Durham North Carolina
| | - Wendell G. Yarbrough
- Division of Otolaryngology, Department of Surgery; Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
- Department of Pathology; Yale School of Medicine; New Haven Connecticut
| | - Benjamin L. Judson
- Division of Otolaryngology, Department of Surgery; Yale School of Medicine; New Haven Connecticut
- Yale Cancer Center; New Haven Connecticut
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Roh JL, Kim SA. Reply to pretreatment depression as a prognostic indicator of survival and nutritional status in patients with head and neck cancer. Cancer 2016; 122:972-3. [PMID: 26696264 DOI: 10.1002/cncr.29849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Shin-Ae Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Carmona R, Zakeri K, Green G, Hwang L, Gulaya S, Xu B, Verma R, Williamson CW, Triplett DP, Rose BS, Shen H, Vaida F, Murphy JD, Mell LK. Improved Method to Stratify Elderly Patients With Cancer at Risk for Competing Events. J Clin Oncol 2016; 34:1270-7. [PMID: 26884579 DOI: 10.1200/jco.2015.65.0739] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare a novel generalized competing event (GCE) model versus the standard Cox proportional hazards regression model for stratifying elderly patients with cancer who are at risk for competing events. METHODS We identified 84,319 patients with nonmetastatic prostate, head and neck, and breast cancers from the SEER-Medicare database. Using demographic, tumor, and clinical characteristics, we trained risk scores on the basis of GCE versus Cox models for cancer-specific mortality and all-cause mortality. In test sets, we examined the predictive ability of the risk scores on the different causes of death, including second cancer mortality, noncancer mortality, and cause-specific mortality, using Fine-Gray regression and area under the curve. We compared how well models stratified subpopulations according to the ratio of the cumulative cause-specific hazard for cancer mortality to the cumulative hazard for overall mortality (ω) using the Akaike Information Criterion. RESULTS In each sample, increasing GCE risk scores were associated with increased cancer-specific mortality and decreased competing mortality, whereas risk scores from Cox models were associated with both increased cancer-specific mortality and competing mortality. GCE models created greater separation in the area under the curve for cancer-specific mortality versus noncancer mortality (P < .001), indicating better discriminatory ability between these events. Comparing the GCE model to Cox models of cause-specific mortality or all-cause mortality, the respective Akaike Information Criterion scores were superior (lower) in each sample: prostate cancer, 28.6 versus 35.5 versus 39.4; head and neck cancer, 21.1 versus 29.4 versus 40.2; and breast cancer, 24.6 versus 32.3 versus 50.8. CONCLUSION Compared with standard modeling approaches, GCE models improve stratification of elderly patients with cancer according to their risk of dying from cancer relative to overall mortality.
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Affiliation(s)
- Ruben Carmona
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Kaveh Zakeri
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Garrett Green
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Lindsay Hwang
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Sachin Gulaya
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Beibei Xu
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Rohan Verma
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Casey W Williamson
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Daniel P Triplett
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Brent S Rose
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Hanjie Shen
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Florin Vaida
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - James D Murphy
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Loren K Mell
- Ruben Carmona, Kaveh Zakeri, Garrett Green, Sachin Gulaya, Beibei Xu, Rohan Verma, Casey W. Williamson, Daniel P. Triplett, Hanjie Shen, James D. Murphy, and Loren K. Mell, University of California, San Diego, La Jolla; Florin Vaida, University of California San Diego Medical Center, San Diego, CA; Lindsay Hwang, Case Western Reserve University, Cleveland, OH; and Brent S. Rose, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA.
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Effect of polypharmacy and potentially inappropriate medications on treatment and posttreatment courses in elderly patients with head and neck cancer. J Cancer Res Clin Oncol 2016; 142:1031-40. [DOI: 10.1007/s00432-015-2108-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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Kwon M, Roh JL, Song J, Lee SW, Kim SB, Choi SH, Nam SY. Effect of metformin on progression of head and neck cancers, occurrence of second primary cancers, and cause-specific survival. Oncologist 2015; 20:546-53. [PMID: 25802404 DOI: 10.1634/theoncologist.2014-0426] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/09/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effect of metformin on progression of head and neck cancers, occurrence of second primary cancers, and cause-specific survival. METHODS This study analyzed a retrospective cohort of 1,151 consecutive patients with head and neck squamous cell carcinoma who were treated at our hospital. Patients were divided into three groups: nondiabetic, nonmetformin, and metformin. Clinical characteristics, recurrence of index head and neck cancer, occurrence of second primary cancer, and survival were compared among the different groups. RESULTS Of 1,151 patients, 99 (8.6%) were included in the metformin group, 79 (6.8%) were in the nonmetformin group, and 973 (84.5%) were in the nondiabetic group. Diabetic status and metformin exposure had no significant impact on index head and neck cancer recurrence or second primary cancer development (p > .2). The nonmetformin group showed relatively lower overall (p = .017) and cancer-specific (p = .054) survival rates than the other groups in univariate analyses, but these results were not confirmed in multivariate analyses. CONCLUSION Metformin use did not show beneficial effects on index tumor progression, second primary cancer occurrence, and cause-specific survival in patients with head and neck cancer compared with nonmetformin users and nondiabetic patients.
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Affiliation(s)
- Minsu Kwon
- Departments of Otolaryngology, Clinical Epidemiology and Biostatistics, Radiation Oncology, and Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Departments of Otolaryngology, Clinical Epidemiology and Biostatistics, Radiation Oncology, and Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jihyun Song
- Departments of Otolaryngology, Clinical Epidemiology and Biostatistics, Radiation Oncology, and Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lee
- Departments of Otolaryngology, Clinical Epidemiology and Biostatistics, Radiation Oncology, and Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Departments of Otolaryngology, Clinical Epidemiology and Biostatistics, Radiation Oncology, and Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Departments of Otolaryngology, Clinical Epidemiology and Biostatistics, Radiation Oncology, and Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Departments of Otolaryngology, Clinical Epidemiology and Biostatistics, Radiation Oncology, and Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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