Does age influence disease‐specific survival in patients with squamous cell carcinomas of the head and neck?

Abstract

Background and Objectives: The number of patients diagnosed with head and neck squamous cell carcinoma (HNSCC) at an advanced age has increased. The aim of this study is to evaluate the age at which disease-specific survival (DSS) significantly decreases in HNSCC. Methods:We performed a retrospective study of 5469 patients with HNSCC treated at our center . External validation with 2082 oral squamous cell carcinomas from a collaborative institution from another continent was performed. Results:We observed an orderly decrease in overall survival as age at diagnosis increased. There were no differences in DSS based on age for patients <80 years old (P = .623), while older patients had a significant decrease in DSS. These results were validated in the independent dataset. In a multivariable analysis performed in the test set, compared to patients <80 years old, patients between 80 to 85 had a 1.50 times higher risk of disease-specific death (95% confidence interval [CI]: 1.19-1.89; P = .001), and patients >85 had a 2.19 times higher risk (95% CI: 1.68-2.87; P < .001).Conclusions: DSS started to significantly decrease in HNSCC at 80 years old. These findings, validated in an independent cohort, indicate that chronological age on its own should not withhold curative treatment in the majority of patients with HNSCC.

Empirical comparison of routinely collected electronic health record data for head and neck cancer‐specific survival in machine‐learnt prognostic models

“…26 CSS at any time is higher in patients with nasopharynx cancer compared to oropharynx or hypopharynx cancers. 27 Our results add to this body of work, whereby patients with salivary gland, oral cavity, and hypopharynx cancer have worse 2-year CSS compared to patients with oropharynx cancer. Fitness for operation is an important patient factor which influences hypopharyngeal CSS 1 ; however, our results demonstrate that this feature may also be important in other head and neck subsites, warranting further investigation.…”

“…Larynx patients also have improved 5‐year CSS when compared to oral cavity patients at 5 years 26 . CSS at any time is higher in patients with nasopharynx cancer compared to oropharynx or hypopharynx cancers 27 . Our results add to this body of work, whereby patients with salivary gland, oral cavity, and hypopharynx cancer have worse 2‐year CSS compared to patients with oropharynx cancer.…”

Predictors for Adherence to Treatment Strategies in Elderly HNSCC Patients

“…For instance, only 2% of patients between 45 and 60 without comorbidities do not receive a guideline-based therapy, whereas more than 10% of patients older than 70, also without comorbidities, are treated with non-standard therapies [ 7 ]. In this context, one must keep in mind that chronological age should not prevent patients from receiving curative treatment [ 9 ]. The comorbidities that increase the probability of treatment-related adverse events and predict a disadvantageous outcome are of higher importance [ 10 , 11 , 12 , 13 ].…”

Outcomes of curative treatment for head and neck squamous cell carcinoma in very elderly adults ≥80 years old

“…Studies often define elderly age starting at 65-70 years old despite evidence showing significant decrease in HNSCC survival starting at 80 years old. 13 There is limited data looking specifically at patients over the age of 80. One study looking at treatment outcomes for locally advanced (stage III and IV) HNSCC in patients over the age of 80 found poor median survival, calling into question whether treatment is futile for elderly patients with locally advanced disease.…”

“…Though studies have observed acceptable tolerance to curative treatment in elderly patients, most studies vary in what constitutes an elderly patient. Studies often define elderly age starting at 65–70 years old despite evidence showing significant decrease in HNSCC survival starting at 80 years old 13 . There is limited data looking specifically at patients over the age of 80.…”