Comorbidity impairs tumor-specific survival of patients with advanced squamous cell carcinoma of the head and neck-region

Introduction Comorbidity influences treatment decision, complication rate and survival of patients suffering from cancer. The negative impact on overall survival (OS), disease-free survival (DFS) and non-cancer-specific survival (NCSS) of patients with head and neck squamous cell carcinoma (HNSCC) was already demonstrated. Until now, the influence of comorbidity on tumor-specific (TSS) and event-free (EFS) survival was not sufficiently assessed.

Methods Within two clinical studies (TRANSCAN-DietINT, 176-15-01062015/ NCT02869399, and NICEI-CIH 202-10-12072010/ 341-15-05102015) the comorbid burden of 75 patients with advanced HNSCC was assessed and rated by the Charlson Score (CS). Statistical analyses were performed in SPSS using receiver operating characteristic (ROC) and Kaplan-Meier curves (log-rank-test) for OS, EFS and TSS in particular.

Results Comorbidity (CS>0) was present in 42.7 % of patients (43/75; mean 0.96; standard error of mean 0.167; range 0 to 6). In ROC curves a significant association between survival and CS was found (area under the curve, AUC>0.65, p< 0.05). The optimal cut off was 0.5 calculated by the Youden Index. Patients with CS >0 showed a significantly decreased OS and EFS compared to patients free from comorbid burden (both p< 0.05). Median TSS was significantly reduced in patients with CS >0 compared to patients with CS=0 (45 vs. 75 months, p = 0.03).

Conclusion Comorbidity does not only decrease OS and EFS of patients with HNSCC but also impairs TSS significantly. Thus, the assessment of CS is recommended and should be considered for stratification or to facilitate correct interpretation of clinical studies.

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Publication History

Article published online:
10 June 2020