This article is more than 5 years old. Information may no longer be current.
Risk factors may predict post-surgical survival for recurrent HNSCC
Click Here to Manage Email Alerts
Several crucial risk factors — including medical comorbidity, age, tumor stage and disease-free interval — should be considered when selecting patients to undergo salvage surgery for recurrent head and neck squamous cell carcinoma, according to the results of a retrospective study.
Patients with these risk factors should be considered for palliative care measures, the researchers wrote.
Surgical salvage for recurrent head and neck squamous cell carcinoma (HNSCC) is associated with substantial morbidity and mortality risks, according to study background. Risk factors for death within 1 year of surgery should be better defined.
Thus, Seungwon Kim, MD, assistant professor of otolaryngology at University of Pittsburgh Medical Center, and colleagues sought to define preoperative prognostic factors predictive of short-term survival — defined as less than 1 year — following salvage surgery in patients with HNSCC. They assessed whether preoperative age and comorbidity predicted 1-year mortality.
Kim and colleagues retrospectively reviewed the medical records of 191 patients (71% men) with recurrent HNSCC surgically treated between January 2003 and December 2013.
The majority of patients had cancer of the larynx (n = 72) or oral cavity cancer (n = 72). Other cancer types included oropharynx cancer (n = 38) and hypopharynx cancer (n = 9).
Survival 1 year after surgery served as the primary endpoint. Length of inpatient hospital stay, days of admissions and skilled nursing facility disposition within 1 year served as secondary endpoints.
The researchers also calculated pre-salvage Charlson-Age Comorbidity Index (CACI).
After a mean follow-up of 20 months (interquartile range [IQR], 10-34), 53 patients (27.7%) died within 1 year of salvage surgery. Patients who died within 1 year had more total inpatient admissions, longer total length of hospital stay and higher risk for discharge to a skilled nursing facility (P < .001 for all).
Further, these patients spent 17.3% of their remaining days in the hospital (IQR, 5.2-36.3).
Independent risk factors for death within 1 year of surgery included higher CACI (RR = 1.43 per unit increase; 95% CI, 1.16-1.76), primary T3 or T4 tumors (RR = 2.34; 95% CI, 1.27-4.31) and having a disease-free interval of less than 6 months (RR = 5.61; 95% CI, 1.78-16.7).
The researchers acknowledged limitations of their study, including the fact that clinical stages for recurrent cancer were not included.
“Most patients will survive at least 1 year after surgery for recurrent HNSCC, but many will not,” Kim and colleagues wrote. “Careful selection of patients for salvage surgery for recurrent HNSCC is essential for optimizing outcomes after salvage surgery and decreasing short-term patient mortality. … The treatment decision for aggressive therapy must ultimately justify the risks, morbidity, and high economic costs that are associated with it.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts