Early mortality after diagnosis of cancer of the head and neck – A population-based nationwide study

English version

Autoři: Charbél Talani ^aff001; Antti Mäkitie ^aff003; Martin Beran ^aff006; Erik Holmberg ^aff007; Göran Laurell ^aff008; Lovisa Farnebo ^aff001
Působiště autorů: Division of Speech language pathology, Audiology and Otorhinolaryngology, Department of Clinical and Experimental medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden ^aff001; Department of Otorhinolaryngology in Linköping, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden ^aff002; Department of Otorhinolaryngology–Head and Neck Surgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland ^aff003; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden ^aff004; Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland ^aff005; Department of ENT and Maxillofacial Surgery, NAL Medical Center Hospital, Trollhattan, Sweden ^aff006; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden ^aff007; Department of Clinical Sciences, ENT, Uppsala University, Uppsala, Sweden ^aff008
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0223154

Souhrn

Background

Cancers of the head and neck have a high mortality rate, and roughly 10% of the patients die within six months of diagnosis. To our knowledge little has been written about this group.

We wished to identify risk factors for early death, to predict and monitor patients at risk better and, if possible, avoid unjustified major treatment.

Methods and findings

This population-based nationwide study from the Swedish Head and Neck Cancer Register (SweHNCR) included data from 2008–2015 and 9733 patients at potential risk of early death.

A total of 925 (9.5%) patients died within six months. For every year older the patients became, the risk of early death increased by 2.3% (p<0.001). The relative risk of death was 3.37 times higher (237%) for patients with WHO score 1 compared with WHO score 0. A primary tumour in the hypopharynx correlated with a 24% increased risk over the oral cavity (p<0.024). Patients with stage IV disease had a 3.7 times greater risk of early death than those with stage I (p<0.001). As expected, a 12 times increased risk of early death was noted in the palliative treatment group, compared to the curative group.

Limitations to this study were that the actual cause of death was not recorded in the SweHNCR, and that socioeconomic factors, alcohol consumption, smoking habits, and HPV status, were not reported in SweHNCR until 2015. However, the fact that this is a population-based nationwide study including 9733 patients compensates for some of these limitations.

Conclusions

Identification of patients at increased risk of early death shows that older patients with advanced disease, increased WHO score, primary tumour in the hypopharynx, and those given palliative treatment, are more likely than the others to die from head and neck cancer within six months of diagnosis.

Klíčová slova:

Cancer treatment – Head – Cancer detection and diagnosis – Surgical and invasive medical procedures – Neck – Sweden – Head and neck cancers – Salivary glands

Zdroje

1. Wikland EMaR. Huvud-hals-cancer [Internet] Stockholm: Cancerfonden; 2016 [updated 16-01-14; cited 2017 october 4]. Available from: https://www.cancerfonden.se/om-cancer/huvud-hals-cancer.

2. Seiwert TY, Cohen EE. State-of-the-art management of locally advanced head and neck cancer. Br J Cancer. 2005;92(8):1341–8. Epub 2005/04/23. doi: 10.1038/sj.bjc.6602510 15846296; PubMed Central PMCID: PMC2361996.

3. Kowalski LP, Carvalho AL. Natural history of untreated head and neck cancer. Eur J Cancer. 2000;36(8):1032–7. Epub 2000/07/08. doi: 10.1016/s0959-8049(00)00054-x 10885608.

4. Mroueh R, Haapaniemi A, Saarto T, Gronholm L, Grenman R, Salo T, et al. Non-curative treatment of patients with oral tongue squamous-cell carcinoma. Eur Arch Otorhinolaryngol. 2019. Epub 2019/05/10. doi: 10.1007/s00405-019-05456-y 31069467.

5. Ledeboer QC, van der Schroeff MP, Pruyn JF, de Boer MF, Baatenburg de Jong RJ, van der Velden LA. Survival of patients with palliative head and neck cancer. Head Neck. 2011;33(7):1021–6. Epub 2010/10/23. doi: 10.1002/hed.21572 20967869.

6. Heinonen T, Loimu V, Saarilahti K, Saarto T, Makitie A. End-of-life care pathway of head and neck cancer patients: single-institution experience. Eur Arch Otorhinolaryngol. 2018;275(2):545–51. Epub 2017/12/17. doi: 10.1007/s00405-017-4843-x 29247265.

7. Almangush A, Coletta RD, Bello IO, Bitu C, Keski-Santti H, Makinen LK, et al. A simple novel prognostic model for early stage oral tongue cancer. Int J Oral Maxillofac Surg. 2015;44(2):143–50. doi: 10.1016/j.ijom.2014.10.004 25457829.

8. Rettig EM, D'Souza G. Epidemiology of head and neck cancer. Surg Oncol Clin N Am. 2015;24(3):379–96. doi: 10.1016/j.soc.2015.03.001 25979389.

9. Farnebo L, Malila N, Makitie A, Laurell G. Early death among head and neck cancer patients. Curr Opin Otolaryngol Head Neck Surg. 2016;24(2):115–20. doi: 10.1097/MOO.0000000000000236 26735585.

10. Hegde JV, Shaverdian N, Felix C, Wang PC, Veruttipong D, Hsu S, et al. Functional Outcomes After De-escalated Chemoradiation Therapy for Human Papillomavirus-Positive Oropharyngeal Cancer: Secondary Analysis of a Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2018;100(3):647–51. Epub 2017/12/17. doi: 10.1016/j.ijrobp.2017.10.045 29246721.

11. Kim JW, Byeon HK, Choi HS, Lee IJ. Dose de-escalation to the normal larynx using conformal radiotherapy reduces toxicity while maintaining oncologic outcome for T1/T2 glottic cancer. Sci Rep. 2017;7(1):15732. Epub 2017/11/18. doi: 10.1038/s41598-017-15974-6 29147004; PubMed Central PMCID: PMC5691141.

12. van Deudekom FJ, van der Velden LA, Zijl WH, Schimberg AS, Langeveld AP, Slingerland M, et al. Geriatric assessment and 1-year mortality in older patients with cancer in the head and neck region: A cohort study. Head Neck. 2019. Epub 2019/03/01. doi: 10.1002/hed.25714 30816619.

13. Massa ST, Cass LM, Challapalli S, Zahirsha Z, Simpson M, Ward G, et al. Demographic predictors of head and neck cancer survival differ in the elderly. Laryngoscope. 2019;129(1):146–53. Epub 2018/09/09. doi: 10.1002/lary.27289 30194774.

14. Lal P, Nautiyal V, Verma M, Yadav R, Maria Das KJ, Kumar S. Objective and subjective assessment of xerostomia in patients of locally advanced head-and-neck cancers treated by intensity-modulated radiotherapy. J Cancer Res Ther. 2018;14(6):1196–201. Epub 2018/11/30. doi: 10.4103/jcrt.JCRT_200_17 30488829.

15. Peng LC, Hui X, Cheng Z, Bowers MR, Moore J, Cecil E, et al. Prospective evaluation of patient reported swallow function with the Functional Assessment of Cancer Therapy (FACT), MD Anderson Dysphagia Inventory (MDADI) and the Sydney Swallow Questionnaire (SSQ) in head and neck cancer patients. Oral Oncol. 2018;84:25–30. Epub 2018/08/18. doi: 10.1016/j.oraloncology.2018.05.012 30115472.

16. Cancercentrum. Årsrapport nationellt kvalitetsregister 2016 [internet]: Regionala Cancercentrum i samverkan; 2016 [updated 17-11-27; cited 2017 October 4]. Available from: https://www.cancercentrum.se/globalassets/cancerdiagnoser/huvud-och-hals/kvalitetsregister/arsrapport-swehncr-2015_161020_slutversion.pdf.

17. Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–55. Epub 1982/12/01. 7165009.

18. Schmidt CO, Kohlmann T. When to use the odds ratio or the relative risk? Int J Public Health. 2008;53(3):165–7. Epub 2009/01/09. 19127890.

19. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. Journal of the American statistical association. 1958;53(282):457–81.

20. Cuzick J. A Wilcoxon-type test for trend. Stat Med. 1985;4(1):87–90. Epub 1985/01/01. doi: 10.1002/sim.4780040112 3992076.

21. Copper C, Pearson E. The use of confidence or fiducial limits illustrated in the case of the binomal. Biometrika. 1934;26:404–13.

22. College Station TSL. Stata Statistical Software: Release 15. 2017.

23. Svahn MF, Munk C, Nielsen TS, von Buchwald C, Frederiksen K, Kjaer SK. Trends in all-cause five-year mortality after head and neck cancers diagnosed over a period of 33 years. Focus on estimated degree of association with human papillomavirus. Acta Oncol. 2016;55(9–10):1084–90. doi: 10.1080/0284186X.2016.1185148 27550781.

24. Loizou C, Laurell G, Lindquist D, Ofverman C, Stefansson K, Nylander K, et al. Incidence of tonsillar cancer in northern Sweden: Impact of human papilloma virus. Oncol Lett. 2015;10(6):3565–72. doi: 10.3892/ol.2015.3775 26788170; PubMed Central PMCID: PMC4665991.

25. Sinevici N, O'Sullivan J. Oral cancer: Deregulated molecular events and their use as biomarkers. Oral Oncol. 2016;61:12–8. doi: 10.1016/j.oraloncology.2016.07.013 27688099.

26. Abrahao R, Keogh RH, Lichtensztajn DY, Marcos-Gragera R, Medeiros BC, Coleman MP, et al. Predictors of early death and survival among children, adolescents and young adults with acute myeloid leukaemia in California, 1988–2011: a population-based study. Br J Haematol. 2016;173(2):292–302. doi: 10.1111/bjh.13944 26847024; PubMed Central PMCID: PMC4833652.

27. Urban RR, He H, Alfonso R, Hardesty MM, Gray HJ, Goff BA. Ovarian cancer outcomes: Predictors of early death. Gynecol Oncol. 2016;140(3):474–80. doi: 10.1016/j.ygyno.2015.12.021 26743531.

28. Massa ST, Osazuwa-Peters N, Christopher KM, Arnold LD, Schootman M, Walker RJ, et al. Competing causes of death in the head and neck cancer population. Oral Oncol. 2017;65:8–15. doi: 10.1016/j.oraloncology.2016.12.006 28109473.

29. Divi V, Chen MM, Nussenbaum B, Rhoads KF, Sirjani DB, Holsinger FC, et al. Lymph Node Count From Neck Dissection Predicts Mortality in Head and Neck Cancer. J Clin Oncol. 2016. doi: 10.1200/JCO.2016.67.3863 27480149.

30. Santos TS, Estevao R, Antunes L, Certal V, Silva JC, Monteiro E. Clinical and histopathological prognostic factors in locoregional advanced laryngeal cancer. J Laryngol Otol. 2016;130(10):948–53. doi: 10.1017/S002221511600880X 27774922.

31. Jakobsen KK, Gronhoj C, Jensen DH, Karnov KKS, Agander TK, Specht L, et al. Increasing incidence and survival of head and neck cancers in Denmark: a nation-wide study from 1980 to 2014. Acta Oncol. 2018:1–9. doi: 10.1080/0284186X.2018.1438657 29447088.

32. Chiesa Estomba CM, Betances Reinoso FA, Osorio Velasquez A, Castro Macia O, Gonzalez Cortes MJ, Araujo Nores J. Carotid blowout syndrome in patients treated by larynx cancer. Braz J Otorhinolaryngol. 2016. doi: 10.1016/j.bjorl.2016.08.013 27789194.

33. Spiotto MT, Koshy M. Hospitalizations of more than 5 days predict for worse outcomes after radiotherapy for head and neck cancer. J Community Support Oncol. 2015;13(10):367–73. doi: 10.12788/jcso.0175 26862912.

34. Sawabe M, Ito H, Oze I, Hosono S, Kawakita D, Tanaka H, et al. Heterogeneous impact of drinking according to treatment method on survival in head and neck cancer: a prospective study. Cancer Sci. 2016. doi: 10.1111/cas.13115 27801961.

35. Kang H-S, Roh J-L, Lee S-w, Kim S-B, Choi S-H, Nam SY, et al. Noncancer-Related Health Events and Mortality in Head and Neck Cancer Patients After Definitive Radiotherapy: A Prospective Study. Medicine. 2016;95(19):e3403. doi: 10.1097/MD.0000000000003403 PMC4902482. 27175640

36. Cao W, Liu Z, Gokavarapu S, Chen Y, Yang R, Ji T. Reformed smokers have survival benefits after head and neck cancer. Br J Oral Maxillofac Surg. 2016;54(7):818–25. doi: 10.1016/j.bjoms.2016.06.013 27364312.

37. Hagedoorn P, Vandenheede H, Vanthomme K, Willaert D, Gadeyne S. A cohort study into head and neck cancer mortality in Belgium (2001–11): Are individual socioeconomic differences conditional on area deprivation? Oral Oncol. 2016;61:76–82. doi: 10.1016/j.oraloncology.2016.08.014 27688108.

38. van Imhoff LC, Kranenburg GG, Macco S, Nijman NL, van Overbeeke EJ, Wegner I, et al. Prognostic value of continued smoking on survival and recurrence rates in patients with head and neck cancer: A systematic review. Head Neck. 2016;38 Suppl 1:E2214–20. doi: 10.1002/hed.24082 25900211.

39. Rieke K, Schmid KK, Lydiatt W, Houfek J, Boilesen E, Watanabe-Galloway S. Depression and survival in head and neck cancer patients. Oral Oncol. 2017;65:76–82. doi: 10.1016/j.oraloncology.2016.12.014 28109472.

40. Lop J, Garcia J, Lopez M, Taberna M, Mena M, Alemany L, et al. Competing mortality in oropharyngeal carcinoma according to human papillomavirus status. Head Neck. 2018. Epub 2018/12/15. doi: 10.1002/hed.25559 30549389.

41. Sivars L, Bersani C, Grun N, Ramqvist T, Munck-Wikland E, Von Buchwald C, et al. Human papillomavirus is a favourable prognostic factor in cancer of unknown primary in the head and neck region and in hypopharyngeal cancer. Mol Clin Oncol. 2016;5(6):671–4. doi: 10.3892/mco.2016.1050 28105346; PubMed Central PMCID: PMC5228397.