Introduction:
Comorbidity in patients with head and neck squamous cell carcinoma (HNSCC) influences
treatment decision and clinical course. Comprehensive analyses of the impact of localization,
other tumor characteristics, comorbidity and lifestyle-associated risk factors on
overall survival (OS), tumor-specific survival (TSS) and non-cancer-related death
(NCD) are desirable.
Methods:
OS, TSS and NCD of 347 patients with advanced HNSCC of the larynx, hypo- and oropharynx
(n = 97/111/139; mean follow-up 42.8, 95% confidence interval 39.2 – 46.4, median
36.4 months) were analyzed using Kaplan-Meier curves (log-rank test) and Cox proportional
hazard models (CPHM) in SPSS, evaluating the association between risk factors (smoking,
alcohol consumption and age) and comorbidity (assessed by Charlson-Score, CS).
Results:
According to univariate analyses, comorbidity impairs OS and NCD (p = 0.038; p = 0.002),
not TSS. Age at diagnosis impacts NCD (p = 0.019), but despite TSS tending to be better
in patients aged > 61 years (p = 0.066) did not affect OS (p = 0.748). TSS was predominantly
dependent on tumor characteristics (localization, T4-stage, N-stage > 1, UICC IVB)
as well as on alcohol consumption > 60 g/d and smoking (all p < 0.02). Multivariate
CPHM confirmed alcohol consumption > 60 g/d and tumor characteristics as factors significantly
reducing TSS, while NCD depends on age, CS and smoking (all p < 0.03), but not on
localization and other tumor characteristics. Multivariate CPHM demonstrated a significant
impact of tumor-characteristics, alcohol, age and CS> 0 on OS.
Conclusion:
Comorbidity, alcohol consumption and smoking are independent predictive survival parameters
for OS, TSS and NCD, thus their consideration as covariates for stratification in
clinical studies is recommended.
