Comorbidity in head and neck cancer: Is it associated with therapeutic delay, post-treatment mortality and survival in a population-based study?

被引:23
|
作者
Stordeur, Sabine [1 ]
Schillemans, Viki [2 ]
Savoye, Isabelle [1 ]
Vanschoenbeek, Katrijn [2 ]
Leroy, Roos [1 ]
Macq, Gilles [2 ]
Verleye, Leen [1 ]
De Gendt, Cindy [2 ]
Nuyts, Sandra [3 ]
Vermorken, Jan [4 ,5 ]
Beguin, Claire [6 ]
Gregoire, Vincent [7 ]
Van Eycken, Liesbet [2 ]
机构
[1] Belgian Hlth Care Knowledge Ctr KCE, Blvd Jardin Bot 55, B-1000 Brussels, Belgium
[2] Belgian Canc Registry, Rue Royale 215, B-1210 Brussels, Belgium
[3] Univ Leuven, Univ Hosp Leuven, Dept Radiotherapy Oncol, KU Leuven, Herestr 49, B-3000 Leuven, Belgium
[4] Antwerp Univ Hosp, Dept Med Oncol, Wilrijkstr 10, B-2650 Edegem, Belgium
[5] Univ Antwerp, Fac Med & Hlth Sci, Univ Pl 1, B-2610 Antwerp, Belgium
[6] Clin Univ St Luc, Ave Hippocrate 10, B-1200 Woluwe St Lambert, Belgium
[7] Ctr Leon Berard, 28 Rue Laennec, F-69373 Lyon, France
关键词
Charlson comorbidity index; Performance status; Head and neck cancer; Population-based study; Survival; Mortality; Time-to-treatment; SHORT-TERM MORTALITY; WAITING-TIMES; INDEX; IMPACT; ICD-9-CM; SURGERY; COMPLICATIONS; OROPHARYNX; MORBIDITY; PROGNOSIS;
D O I
10.1016/j.oraloncology.2019.104561
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Objectives: This study aims to investigate the relationship between comorbidities and therapeutic delay, post-treatment mortality, overall and relative survival in patients diagnosed with squamous cell carcinoma of the head and neck (HNSCC). Patients and Methods: 9245 patients with a single HNSCC diagnosed between 2009 and 2014 were identified in the Belgian Cancer Registry. The Charlson Comorbidity Index (CCI) was calculated for 8812 patients (95.3%), distinguishing patients having none (0), mild (1-2), moderate (3-4) or severe comorbidity ( > 4). The relationship between CCI and therapeutic delay was evaluated using the Spearman correlation. Post-treatment mortality was modelled with logistic regression, using death within 30 days as the event. The association between comorbidity and survival was assessed using Cox proportional hazard models. Results: Among 8812 patients with a known CCI, 39.2% had at least one comorbidity. Therapeutic delay increased from 31 to 36 days when the CCI worsened from 0 to 4 (rho = 0.087). After case-mix adjustment, higher baseline comorbidity was associated with increased post-surgery mortality (mild, OR 3.52 [95% CI 1.91-6.49]; severe, OR 18.71 [95% CI 6.85-51.12]) and post-radiotherapy mortality (mild, OR 2.23 [95% CI 1.56-3.19]; severe, OR 9.33 [95% CI 4.83-18.01]) and with reduced overall survival (mild, HR 1.39, [95% CI 1.31-1.48]; severe, HR 2.41 [95% CI 2.00-2.90]). That was also the case for relative survival in unadjusted analyses (mild, EHR 1.77 [95% CI 1.64-1.92]; severe, EHR = 4.15 [95% CI 3.43-5.02]). Conclusion: Comorbidity is significantly related to therapeutic delay, post-treatment mortality, 5-year overall and relative survival in HNSCC patients. Therapeutic decision support tools should optimally integrate comorbidity.
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页数:8
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