Comorbidity and prognosis in head and neck cancers: Differences by subsite, stage, and human papillomavirus status

Habbous, Steven; Harland, Luke; Delfa, Anthony La; Fadhel, Ehab; Xu, Wei; Liu, Feifei; Goldstein, David P.; Waldron, John; Huang, Shao Hui; O’Sullivan, Brian; Liu, Geoffrey

doi:10.1002/hed.23360

Cited by 73 publications

(90 citation statements)

References 55 publications

(74 reference statements)

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“…Interestingly, a recent study observed that patients with HPV16 DNA positive oropharyngeal carcinoma and lower levels of comorbidity show a significantly better overall survival compared to patients with HPV16 DNA negative tumours [15]. Specifically for the field of Radiation Oncology, it has been shown that HPV-positivity is a strong prognostic marker for overall survival and/or local tumour control in patients treated with primary radiochemotherapy [16][17][18][19][20]. However, its impact on outcome after PORT-C is not well evaluated so far.…”

mentioning

confidence: 98%

HPV16 DNA status is a strong prognosticator of loco-regional control after postoperative radiochemotherapy of locally advanced oropharyngeal carcinoma: Results from a multicentre explorative study of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG)

Lohaus

Linge

Tinhofer

et al. 2014

Radiotherapy and Oncology

126

141

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confidence: 98%

HPV16 DNA status is a strong prognosticator of loco-regional control after postoperative radiochemotherapy of locally advanced oropharyngeal carcinoma: Results from a multicentre explorative study of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG)

Lohaus

Linge

Tinhofer

et al. 2014

Radiotherapy and Oncology

126

141

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“…For example, Habbous and colleagues, 26 in their study of 525 patients with oropharyngeal cancer, found that after controlling for all other variables including p16 status, a Charlson Comorbidity Index 39 (CCI) score of 2 or greater was associated with a 31% increased risk of death from any cause (aHR, 1.31 [95% CI, 1.02–1.70]) compared with CCI scores of 0 or 1. Likewise, in a recent study by Rietbergen and colleagues 29 that evaluated 841 patients with oropharyngeal cancer with known HPV status, moderate to severe comorbidity, as assessed by ACE-27 scores, was associated with a 62% increased risk of death from any cause (aHR, 1.62 [95% CI, 1.31–2.01]) compared with no comorbidity to mild comorbidity.…”

Section: Discussionmentioning

confidence: 99%

“…24–28 In OPSCC, the prognostic importance of comorbidity is not well defined. Some investigators have shown comorbidity to be an important prognostic factor independent of HPV status, 26,29,30 while others have found that among HPV-positive patients, comorbidity is not prognostic. 31 …”

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confidence: 99%

Prognostic Importance of Comorbidity and the Association Between Comorbidity and p16 in Oropharyngeal Squamous Cell Carcinoma

Skillington

Kallogjeri

Lewis

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Comorbidity affects the prognosis of patients with cancer through the direct effects of the comorbid illness and by influencing the patients’ ability to tolerate treatment and mount a host response. However, the prognostic importance of comorbidity in oropharyngeal squamous cell carcinoma is not well characterized in the era of human papillomavirus infection. OBJECTIVE To determine the prognostic importance of comorbidity in both p16-positive and p16-negative oropharyngeal squamous cell carcinoma and to explore the relationship between comorbidity and p16. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 305 patients at a single tertiary referral center diagnosed as having oropharyngeal squamous cell carcinoma between June 1996 and June 2010, but without a history of head and neck cancer or distant metastasis at time of diagnosis. The data were analyzed from August 1, 2014, through April 30, 2015. EXPOSURES Patients were grouped according to p16 status. MAIN OUTCOMES AND MEASURES Overall survival, defined as the time from diagnosis to death from any cause. Disease-free survival, defined as the time from diagnosis to either death from any cause or the first documented local, regional, or distant recurrence. RESULTS Of the 305 patients who met eligibility criteria, 230 were p16-positive, 70 were p16-negative, and 5 were not evaluable for p16 status. The final cohort of 300 patients had a mean (SD) age of 56.3 (9.3) years and 262 (87%) were male. In Kaplan-Meier analysis, the 5-year overall survival rates were 71%(95% CI, 65%–76%) for 232 patients with no comorbidity to mild comorbidity and 49%(95% CI, 36%–61%) for 63 patients with moderate to severe comorbidity. In multivariate Cox proportional hazards analysis, moderate to severe comorbidity was associated with an increased risk of death from any cause (adjusted hazards ratio [aHR], 1.52 [95% CI, 0.99–2.32]) and increased risk of death or recurrence (aHR, 1.71 [95% CI, 1.13–2.59]). After stratifying by p16 status and controlling for other variables, moderate to severe comorbidity was significantly associated with increased risk of death from any cause among p16-negative patients (aHR, 1.90 [95% CI, 1.03–3.50]) but not among p16-positive patients (aHR, 1.11 [95% CI, 0.61–2.02]). CONCLUSIONS AND RELEVANCE Comorbidity is important to consider when assessing the prognosis of patients with oropharyngeal squamous cell carcinoma and is of greater prognostic value in p16-negative than p16-positive cancer.

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“…Weaknesses of this study include bias in treatments, as patients who underwent primary RT compared to surgery had higher Charleston Co-Morbidity Index (CCI) [13], and a higher proportion of T4b disease. We are missing human papilloma virus (HPV) status on the majority of our patients, as our centre did not routinely test for p16 status until 2010/2011, which limits comparisons on comparing modalities when stratifying by HPV status.…”

Section: Discussionmentioning

confidence: 99%

Survival Outcomes and Patterns of Recurrence in Patients with Stage III or IV Oropharyngeal Cancer Treated with Primary Surgery or Radiotherapy

Debenham¹,

Banerjee

Warkentin³

et al. 2016

Cureus

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PurposeTo compare and contrast the patterns of failure in patients with locally advanced squamous cell oropharyngeal cancers undergoing curative-intent treatment with primary surgery or radiotherapy +/- chemotherapy.Methods and materialsTwo hundred and thirty-three patients with stage III or IV oropharyngeal squamous cell carcinoma who underwent curative-intent treatment from 2006-2012, were reviewed. The median length of follow-up for patients still alive at the time of analysis was 4.4 years. Data was collected retrospectively from a chart review.ResultsOne hundred and thirty-nine patients underwent primary surgery +/- adjuvant therapy, and 94 patients underwent primary radiotherapy +/- chemotherapy (CRT). Demographics were similar between the two groups, except primary radiotherapy patients had a higher age-adjusted Charleston co-morbidity score (CCI). Twenty-nine patients from the surgery group recurred; 15 failed distantly only, seven failed locoregionally, and seven failed both distantly and locoregionally. Twelve patients recurred who underwent chemoradiotherapy; ten distantly alone, and two locoregionally. One patient who underwent radiotherapy (RT) alone failed distantly. Two and five-year recurrence-free survival rates for patients undergoing primary RT were 86.6% and 84.9% respectively. Two and five-year recurrence-free survival rates for primary surgery was 80.9% and 76.3% respectively (p=0.21). There was no significant difference in either treatment when they were stratified by p16 status or smoking status.ConclusionsOur analysis does not show any difference in outcomes for patients treated with primary surgery or radiotherapy. Although the primary pattern of failure in both groups was distant metastatic disease, some local failures may be preventable with careful delineation of target volumes, especially near the base of skull region.

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Comorbidity and prognosis in head and neck cancers: Differences by subsite, stage, and human papillomavirus status

Abstract: Comorbidity was prognostic in subsets of nasopharyngeal, oropharyngeal, oral cavity, and laryngeal cancers. Comorbidity may be a partial surrogate for age and social habits.

Cited by 73 publications

References 55 publications

HPV16 DNA status is a strong prognosticator of loco-regional control after postoperative radiochemotherapy of locally advanced oropharyngeal carcinoma: Results from a multicentre explorative study of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG)

HPV16 DNA status is a strong prognosticator of loco-regional control after postoperative radiochemotherapy of locally advanced oropharyngeal carcinoma: Results from a multicentre explorative study of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG)

Prognostic Importance of Comorbidity and the Association Between Comorbidity and p16 in Oropharyngeal Squamous Cell Carcinoma

Survival Outcomes and Patterns of Recurrence in Patients with Stage III or IV Oropharyngeal Cancer Treated with Primary Surgery or Radiotherapy

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