Age‐adjusted comorbidity and survival in locally advanced laryngeal cancer

Mulcahy, Collin F.; Mohamed, A.S.R.; Kanwar, Aasheesh; Hutcheson, Katherine A.; Ghosh, Alokananda; Vock, David M.; Weber, Randal S.; Lai, Stephen Y.; Gunn, G. Brandon; Zafereo, Mark; Morrison, William H.; Ferrarotto, Renata; Garden, Adam S.; Rosenthal, D.I.; Fuller, Clifton D.

doi:10.1002/hed.25200

Cited by 22 publications

(22 citation statements)

References 21 publications

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“…Presence of comorbidities was common in our population, this finding is similar to other studies [14–19]. In addition, aCCI was a significant prognostic factor for PFS, OS and LFS in our study.…”

Section: Discussionsupporting

confidence: 92%

“…Several previous studies have reported that nodal status is a significant prognostic factor in laryngeal cancer, with higher nodal status being associated to poorer OS [11,14,36–38] although there are limited reports of the association of nodal status and LFS. In our study, the majority of our patients were treated with non-surgical approaches, hence it is not known whether other approaches eg, upfront surgery followed by adjuvant CRT or induction chemotherapy followed by CRT will lead to better outcomes for patients with N2/N3 disease, or whether other methods of intensifying therapy will improve outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Presence of significant comorbidities is common in HNSCC with about 30–50% of patients having at least 1 comorbidity [14–19]. Various indices such as the Charlson comorbidity index (CCI) and ACE-27 have been validated for use in the head and neck cancer population [20–23].…”

Section: Introductionmentioning

confidence: 99%

“…Various indices such as the Charlson comorbidity index (CCI) and ACE-27 have been validated for use in the head and neck cancer population [20–23]. Studies have consistently reported that the presence of comorbidities is associated with poorer overall survival in HNSCC [15–19,24,25] and in particular in LSCC [14,26,27]. Many studies report an effect of comorbidity on OS only, and not cancer-specific survival [14,15,17,19], postulating that this is due to higher non-cancer related mortality, which could affect about between 10–30% of patients [28–31] despite control of their cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Studies have consistently reported that the presence of comorbidities is associated with poorer overall survival in HNSCC [15–19,24,25] and in particular in LSCC [14,26,27]. Many studies report an effect of comorbidity on OS only, and not cancer-specific survival [14,15,17,19], postulating that this is due to higher non-cancer related mortality, which could affect about between 10–30% of patients [28–31] despite control of their cancer. However, other studies report poorer cancer-specific survival in association with comorbidity [27,32], which was attributed to various factors including its detrimental effect on surgical outcomes, higher risk of severe complications during treatment [24,27,32,33], or due to comorbidity leading to a change in therapeutic decisions in up to about 20–30% of patients [34] and/or the use of substandard therapy [35].…”

Section: Introductionmentioning

confidence: 99%

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Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC)

et al. 2019

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AimTreatment strategies in laryngeal squamous cell cancer (LSCC) straddle the need for long term survival and tumor control as well as preservation of laryngeal function as far as possible. We sought to identify prognostic factors affecting LSCC outcomes in our population.MethodsClinical characteristics, treatments and survival outcomes of patients with LSCC were analysed. Baseline comorbidity data was collected and age-adjusted Charlson Comorbidity Index (aCCI) was calculated. Outcomes of overall survival (OS), progression-free survival (PFS) and laryngectomy-free survival (LFS) were evaluated.ResultsTwo hundred and fifteen patients were included, 170 (79%) underwent primary radiation/ chemoradiation and the remainder upfront surgery with adjuvant therapy where indicated. The majority of patients were male, Chinese and current/ex-smokers. Presence of comorbidity was common with median aCCI of 3. Median OS was 5.8 years. On multivariable analyses, high aCCI and advanced nodal status were associated with inferior OS (HR 1.24 per one point increase in aCCI, P<0.001 and HR 3.52; p<0.001 respectively), inferior PFS (HR 1.14; p = 0.007 and HR 3.23; p<0.001 respectively) and poorer LFS (HR 1.19; p = 0.001 and HR 2.95; p<0.001 respectively). Higher tumor (T) stage was associated with inferior OS and LFS (HR 1.61; p = 0.02 and HR 1.91; p = 0.01 respectively).ConclusionIn our Asian population, the presence of comorbidities and high nodal status were associated with inferior OS, PFS and LFS whilst high T stage was associated with inferior LFS and OS.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC)

et al. 2019

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Optimizing Survival Predictions of Hypopharynx Cancer: Development of a Clinical Prediction Model

et al. 2019

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Objectives To develop and validate a clinical prediction model (CPM) for survival in hypopharynx cancer, thereby aiming to improve individualized estimations of survival. Methods Retrospective cohort study of hypopharynx cancer patients. We randomly split the cohort into a derivation and validation dataset. The model was fitted on the derivation dataset and validated on the validation dataset. We used a Cox's proportional hazard model and least absolute shrinkage and selection operator (LASSO) selection. Performance (discrimination and calibration) of the CPM was tested. Results The final model consisted of gender, subsite, TNM classification, Adult Comorbidity Evaluation‐27 score (ACE27), body mass index (BMI), hemoglobin, albumin, and leukocyte count. Of these, TNM classification, ACE27, BMI, hemoglobin, and albumin had independent significant associations with survival. The C Statistic was 0.62 after validation. The model could significantly identify clinical risk groups. Conclusions ACE27, BMI, hemoglobin, and albumin are independent predictors of overall survival. The identification of high‐risk patients can be used in the counseling process and tailoring of treatment strategy or follow‐up. Level of Evidence 4 Laryngoscope , 130:2166–2172, 2020

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Impact of comorbidity scores and lifestyle factors in curative radiotherapy in laryngeal cancer

et al. 2023

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Purpose The principal goal of treatment of laryngeal cancer is to eliminate a tumour while preserving laryngeal function with radio(chemo)therapy being the mainstay of treatment. The aim of this report is to present the influence of comorbidities and lifestyle factors on treatment outcomes in our cohort of patients. Methods During the period 2009–2018, curative radio(chemo)therapy for laryngeal cancer was performed on 189 patients. Results The median OS was 50.8 months, with a mean PFS of 96.5 months, mean LC of 101.4 months and a median follow-up of 38.1 months. Acute and late treatment toxicity grade 3–4 was observed in 39.2% patients and 10.1% patients, respectively. A significant effect on overall survival was confirmed for the baseline PS (performance status), severity of weight loss, baseline haemoglobin values, history of alcohol abuse, marital status and comorbidities according to the Charlson Comorbidity Index, as well as the ACE-27 and ASA scores. Conclusions In our cohort of patients treated with radio(chemo)therapy for laryngeal cancer, we found good therapeutic results and an acceptable side-effect profile. Statistically significant predictors of overall survival were the baseline PS, weight loss, anaemia, associated comorbidities, history of alcohol abuse and marital status.

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Age‐adjusted comorbidity and survival in locally advanced laryngeal cancer

Abstract: 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.

Cited by 22 publications

References 21 publications

Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC)

Association of clinical factors with survival outcomes in laryngeal squamous cell carcinoma (LSCC)

Optimizing Survival Predictions of Hypopharynx Cancer: Development of a Clinical Prediction Model

Impact of comorbidity scores and lifestyle factors in curative radiotherapy in laryngeal cancer

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