Causes of long-term mortality in patients with head and neck squamous cell carcinomas

Abstract

Purpose After treatment of a head and neck squamous cell carcinoma (HNSCC), patients with an adequate control of the tumor have a decreased overall survival when compared to age- and gender-matched controls in the general population. The aim of our study was to analyze the causes of long-term mortality in patients with HNSCC. Methods We carried out a retrospective study of 5122 patients with an index HNSCC treated at our center between 1985 and 2018. We analyzed the survival considering three causes of death: mortality associated with the HNSCC index tumor, mortality associated with a second or successive neoplasm, and mortality associated with a non-cancer cause. Results After the diagnosis of an HNSCC the most frequent cause of death is the head and neck tumor itself during the first 3.5 years of follow-up. Thereafter, mortality is more frequently associated with competing causes of death, such as second malignancies and non-cancer causes. Mortality associated with second and successive neoplasms was 2.3% per year, a percentage that was maintained constant throughout the follow-up. Likewise, mortality attributable to non-cancer causes was 1.6% per year, which also remained constant. There were differences in the mortality patterns according to the characteristics of the patients. Conclusion There are differences in the mortality patterns of patients with HNSCC depending on their characteristics. Knowledge of these patterns can help in the design of guidelines to improve the follow-up protocols of this group of patients to optimize the clinical cost-effectiveness.

Exercise-based rehabilitation on functionality and quality of life in head and neck cancer survivors. A systematic review and meta-analysis

“…HNC accounted for approximately 3% of all cancers in the United States in 2018 and 1.8% of all cancer deaths in the United States during 2020 9 . Particularly, HNcSCC is considered a fatal disease within the first 3.5 years of follow-up, with a relapse mortality rate of 2.3% per year 10 . Depending on anatomical location, they can be located in the lips, pharynx, larynx, paranasal sinus, nasal and oral cavities 11 , 12 .…”

Evaluation of Concomitant Systemic Treatment in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Radiotherapy

“…The overall decreasing benefit of concomitant chemotherapy with higher patient age, as observed in the MACH-NC study, may be related to 2 factors: more (early) non–cancer-related deaths in older adults with HNSCCs that could mask improved locoregional control after chemoradiation, 28 and increased chemotherapy-related toxic effects potentially increasing the risk of premature radiotherapy termination in the short-term 29 , 30 and eventually even increasing the hazard of non–cancer-related deaths in the long-term. 31 , 32 A potential explanation for the discrepant results between the MACH-NC and our study could be related to differences in the patient population (eg, probably higher proportion of patients with HPV-positive oropharyngeal carcinoma with no or limited alcohol and tobacco consumption in our cohort), improved supportive measures over time, 33 more frequent use of chemotherapy regimens that are less toxic and easier to manage (eg, cisplatin weekly), 34 , 35 , 36 and more modern radiotherapy treatment. 37 …”

TRIM21 Expression as a Prognostic Biomarker for Progression-Free Survival in HNSCC

“…However, we did not observe an association between increased TRIM21 expression and a shorter OS, though previous studies have reported on increased mortality rates of HNSCC patients. In addition to PTs, causes of death include new malignant tumors and non-cancer causes such as treatment-related and alcohol- and tobacco-associated comorbidities [ 29 , 30 ]. From the available data in our cohort, we were only able to determine OS and not disease-specific mortality.…”