Clinical outcomes of elderly patients treated for oral cavity squamous cell carcinoma

Publication date: Available online 18 March 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Jie Jane Chen, Jennifer L. Shah, Jeremy P. Harris, Timothy T. Bui, Kurt Schaberg, Christina S. Kong, Michael J. Kaplan, Vasu Divi, David Schoppy, Quynh-Thu Le, Wendy Y. Hara
PurposeOral cavity squamous cell carcinoma (OCSCC) commonly occurs in elderly patients. This study explores clinical outcomes of elderly patients with OCSCC based on their functional status and clinical comorbidities.Methods and MaterialsWe retrospectively reviewed 180 patients aged ≥70 who were treated with definitive intent with surgery followed by adjuvant therapy if indicated for newly-diagnosed OCSCC from 1998 to 2013. Pathology review was conducted, and ECOG performance status and the Head and Neck Charlson Comorbidity Index (HN-CCI) were assessed. We performed Kaplan-Meier analyses and cumulative incidence estimates to assess overall survival (OS), progression-free survival (PFS), and locoregional recurrence (LRR). Univariate and multivariate analyses were used to test age, adjuvant therapy, adverse pathologic features, ECOG status, and HN-CCI status as predictors.ResultsMedian age was 80 years (range: 70-95), with a median follow-up of 23 months. Median OS was 18 months and 46 months for patients aged 70-84 and ≥85, respectively (p=0.0017). LRR was 24% at 1 year and 30% at 2 years for all patients. On univariate analysis, ECOG score ≥2 (HR=1.96 [1.19-3.21], p=0.008) and HN-CCI score ≥2 (HR=1.97 [1.17-3.34], p=0.011) were predictors of worse OS. On multivariate analysis, HN-CCI score was a better predictor of OS, PFS, and LRR than ECOG score. Predictors of worse OS were age ≥85 (HR=1.78 [1.07-2.96], p=0.026), HN-CCI score of ≥2 (HR=2.21 [1.20-4.08], p=0.013), and adverse features (HR=2.35 [1.34-4.13], p=0.003). Adjuvant therapy did not significantly impact OS or LRR for patients with adverse features even though 48% of them did not receive it.ConclusionElderly patients with good health and performance status may live long enough to suffer disease progression from OCSCC. ECOG and HN-CCI scores may be useful to evaluate elderly patient candidacy for adjuvant therapy. However, the benefit of adjuvant therapy in this population remains elusive and should be investigated prospectively.

Teaser

There is limited data on the prognosis and treatment of oral cavity squamous cell carcinoma (OCSCC) in the elderly. We retrospectively reviewed OCSCC patients aged ≥70 at the Stanford Cancer Institute to investigate clinical outcomes based on functional status and comorbidities. Our data suggests that elderly patients with good functional and comorbidity status may live long enough to suffer disease progression. The benefit of adjuvant therapy in elderly patients with OCSCC warrants further investigation.


http://ift.tt/2mWRJhC