Predictors of Survival After Head and Neck Squamous Cell Carcinoma in South America: The InterCHANGE Study

Abstract

PURPOSE Head and neck squamous cell carcinoma (HNSCC) incidence is high in South America, where recent data on survival are sparse. We investigated the main predictors of HNSCC survival in Brazil, Argentina, Uruguay, and Colombia. METHODS Sociodemographic and lifestyle information was obtained from standardized interviews, and clinicopathologic data were extracted from medical records and pathologic reports. The Kaplan-Meier method and Cox regression were used for statistical analyses. RESULTS Of 1,463 patients, 378 had a larynx cancer (LC), 78 hypopharynx cancer (HC), 599 oral cavity cancer (OC), and 408 oropharynx cancer (OPC). Most patients (55.5%) were diagnosed with stage IV disease, ranging from 47.6% for LC to 70.8% for OPC. Three-year survival rates were 56.0% for LC, 54.7% for OC, 48.0% for OPC, and 37.8% for HC. In multivariable models, patients with stage IV disease had approximately 7.6 (LC/HC), 11.7 (OC), and 3.5 (OPC) times higher mortality than patients with stage I disease. Current and former drinkers with LC or HC had approximately 2 times higher mortality than never-drinkers. In addition, older age at diagnosis was independently associated with worse survival for all sites. In a subset analysis of 198 patients with OPC with available human papillomavirus (HPV) type 16 data, those with HPV-unrelated OPC had a significantly worse 3-year survival compared with those with HPV-related OPC (44.6% v 75.6%, respectively), corresponding to a 3.4 times higher mortality. CONCLUSION Late stage at diagnosis was the strongest predictor of lower HNSCC survival. Early cancer detection and reduction of harmful alcohol use are fundamental to decrease the high burden of HNSCC in South America.

The impact of the COVID‐19 pandemic on hospitalizations for oral and oropharyngeal cancer in Brazil

“…This disease may rapidly invade or metastasize, and severe tumours may then require complex surgery and/or radiotherapy (occasionally, chemotherapy) that results in long‐term orofacial deformity, oropharyngeal dryness, trismus, a risk of osteoradionecrosis and reduced quality of life. Advanced cases are also associated with a lower likelihood of survival 2,15,16 . In Brazil, oral cancer is the fifth most incident type in men, comprising 5% of all cancer cases estimated for 2020 17 .…”

“…Advanced cases are also associated with a lower likelihood of survival. 2,15,16 In Brazil, oral cancer is the fifth most incident type in men, comprising 5% of all cancer cases estimated for 2020. 17 Prior research reports have shown an important reduction in the number of soft oral tissue biopsies in Brazil due to the pandemic.…”

Prognostic factors and long-term survival in oral squamous cell carcinoma

“…There is still a great lack of data relative to its clinical outcome, especially in South America (10). Considering Brazil, the studies carried out generally represent data from the Southeast region, to the detriment of the other regions (11).…”

“…The 5-year survival rates of patients with OSCC vary worldwide, from 26% to 72,5% (5, 10, 14-18). In South America, 3-year OS rate for OSCC was 54.7%, however more than half of the participants of the study were treated at private hospitals (10). Among Brazilian studies, the 5-year OS may vary regionally from 24% to 51.7% (6, 7, 20-26), and it was 30% for patients with OSCC undergoing outpatient cancer treatment by Brazilian Unified National Health System (27).…”

Small Extracellular Vesicles from Head and Neck Squamous Cell Carcinoma Cells Carry a Proteomic Signature for Tumor Hypoxia

“…Head and neck squamous cell carcinomas (HNSCCs) are clinically complex and molecularly heterogenous [1]. Despite intensive studies of HNSCC and the development of new therapeutic modalities, the five-year survival rate has remained at 50% for decades [2][3][4]. One hallmark of HNSCC is the presence of hypoxic areas within the tumor tissue.…”