Assessment of Predictive Scoring System for 90-Day Mortality Among Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma Who Have Completed Concurrent Chemoradiotherapy

Abstract

IMPORTANCEThere is currently no system to predict 90-day morality among patients with locally advanced head and neck squamous cell carcinoma (HNSCC) after the completion of concurrent chemoradiotherapy (CCRT). OBJECTIVETo validate the accuracy of a predictive scoring system for 90-day mortality among patients with locally advanced HNSCC who have completed CCRT. DESIGN, SETTING, AND PARTICIPANTSThis prognostic study included 16 029 patients with HNSCC who completed CCRT between January 2006 and December 2015. Data were extracted from the Taiwan Cancer Registry Database. A risk scoring system was developed based on significant risk factors and corresponding risk coefficients. Data analysis was conducted from June 2018 to February 2019. EXPOSURES Mortality within 90 days of completion of definitive CCRT. MAIN OUTCOMES AND MEASURESThe 90-day mortality rate after completion of CCRT and the accuracy of the scoring system, based on a comparison of mortality rates between training and test data sets. RESULTS Among 16 029 patients with locally advanced HNSCC, 1068 (6.66%; 1016 [95.1%] men; mean [SD] age, 55.11 [11.45] years) died before reaching the 90-day threshold, and 14 961 (93.4%; 14 080 [94.1%] men; mean [SD] age, 52.07 [9.99] years) survived. Multivariable analysis revealed that being aged 50 years or older (adjusted hazard ratio [aHR], 1.263; 95% CI, 1.104-1.445; P < .001),

Definitive intensity‐modulated radiotherapy or surgery for early oral cavity squamous cell carcinoma: Propensity‐score‐matched, nationwide, population‐based cohort study

“…In the multivariate analysis, the other risk factors for all‐cause mortality were T2N0M0, male patients, and age ≥61 years. These risk factors for all‐cause mortality were in agreement with the findings of previous studies, which have revealed that higher clinical stage, old age, and male patients are independent poor prognostic factors for OS 5,22,23,31,43 . Surgery resulted in significantly higher OS compared with definitive IMRT in patients with E‐OCSCC (Table 2 and Figure 1).…”

“…46 Further studies incorporating geriatric tools for predictive and interventional purposes will potentially allow for improved patient selection and tolerance to intensive treatment. 22,43 Regardless of age group, advanced clinical stage was an independent poor prognostic factor for OS among patients with E-OCSCC. The present study revealed that T2N0 clinical stage is a prognostic factor for patients with E-OCSCC.…”

“…Unhealthy patients with E-OCSCC and multiple comorbidities could be considered by using other predictive scoring systems to evaluate acute mortality related to these aggressive treatments. 22,43 After PSM, the Cox proportional hazards regression analysis of the death risk among patients with E-OCSCC revealed more favorable outcomes for surgery than for definitive IMRT. In the multivariate analysis, the other risk factors for all-cause mortality were T2N0M0, male patients, and age ≥61 years.…”

“…These data might be not suitable for extrapolation to unhealthy patients with multiple comorbidities. Unhealthy patients with E‐OCSCC and multiple comorbidities could be considered by using other predictive scoring systems to evaluate acute mortality related to these aggressive treatments 22,43 …”

“…Similarly, older patients may require more supportive care throughout the treatment process 46 . Further studies incorporating geriatric tools for predictive and interventional purposes will potentially allow for improved patient selection and tolerance to intensive treatment 22,43 . Regardless of age group, advanced clinical stage was an independent poor prognostic factor for OS among patients with E‐OCSCC.…”