TY - JOUR
T1 - Comorbidity, human papillomavirus infection and head and neck cancer survival in an ethnically diverse population
AU - Ankola, Ashish A.
AU - Smith, Richard V.
AU - Burk, Robert D.
AU - Prystowsky, Michael B.
AU - Sarta, Catherine
AU - Schlecht, Nicolas F.
N1 - Funding Information:
This project is supported in part by NIH grant CA115243 (to NFS) and the Department of Otorhinolaryngology-Head & Neck Surgery, Albert Einstein College of Medicine/Montefiore Medical Center.
PY - 2013/9
Y1 - 2013/9
N2 - Objective To demonstrate the importance of comorbid conditions in head and neck squamous cell carcinoma (HNSCC), we assessed the association between comorbidity and survival in an inner-city population of HNSCC patients. Patients and methods Comorbid status at diagnosis was derived using medical records and the Adult Comorbidity Evaluation-27 (ACE-27) index on 288 patients with histologically confirmed HNSCC from Montefiore Medical Center in the Bronx (NY) between 2002 and 2011. The association between comorbidity, tumor human papillomavirus (HPV) status and overall and disease specific survival was assessed by Kaplan-Meier analysis and multivariable Cox regression adjusting for clinico-pathologic factors. Results The study population consisted of primary oropharyngeal (36%), laryngeal (33%) and oral cavity cancer patients (31%). Overall, 19% had no comorbidity, 43% mild comorbidity, 29% moderate comorbidity, and 9% severe comorbidity. The most common comorbid conditions were hypertension, diabetes mellitus, respiratory disease, other malignancies, and illicit drug use. Survival analyses revealed that increased comorbidity at diagnosis was significantly related to poorer overall survival (p = 0.016), but not to cancer survival (p = 0.369) or recurrence (p = 0.652). Oropharyngeal cancer patients with HPV DNA positive tumors and lower levels of comorbidity had significantly better overall survival compared to patients with HPV negative tumors (hazard ratio = 0.2, 95%CI: 0.04-0.8), however there was no significant difference in overall (or disease specific) survival by HPV status among patients with higher levels of comorbidity at diagnosis (hazard ratio = 0.7, 95%CI: 0.2-2.8). Conclusion In an inner-city predominantly minority population, comorbidity at HNSCC diagnosis is relatively common and associated with poor overall survival, but not cancer survival or recurrence. Interestingly, the relationship between HPV and improved survival appears to be specific to patients with low comorbidity at diagnosis.
AB - Objective To demonstrate the importance of comorbid conditions in head and neck squamous cell carcinoma (HNSCC), we assessed the association between comorbidity and survival in an inner-city population of HNSCC patients. Patients and methods Comorbid status at diagnosis was derived using medical records and the Adult Comorbidity Evaluation-27 (ACE-27) index on 288 patients with histologically confirmed HNSCC from Montefiore Medical Center in the Bronx (NY) between 2002 and 2011. The association between comorbidity, tumor human papillomavirus (HPV) status and overall and disease specific survival was assessed by Kaplan-Meier analysis and multivariable Cox regression adjusting for clinico-pathologic factors. Results The study population consisted of primary oropharyngeal (36%), laryngeal (33%) and oral cavity cancer patients (31%). Overall, 19% had no comorbidity, 43% mild comorbidity, 29% moderate comorbidity, and 9% severe comorbidity. The most common comorbid conditions were hypertension, diabetes mellitus, respiratory disease, other malignancies, and illicit drug use. Survival analyses revealed that increased comorbidity at diagnosis was significantly related to poorer overall survival (p = 0.016), but not to cancer survival (p = 0.369) or recurrence (p = 0.652). Oropharyngeal cancer patients with HPV DNA positive tumors and lower levels of comorbidity had significantly better overall survival compared to patients with HPV negative tumors (hazard ratio = 0.2, 95%CI: 0.04-0.8), however there was no significant difference in overall (or disease specific) survival by HPV status among patients with higher levels of comorbidity at diagnosis (hazard ratio = 0.7, 95%CI: 0.2-2.8). Conclusion In an inner-city predominantly minority population, comorbidity at HNSCC diagnosis is relatively common and associated with poor overall survival, but not cancer survival or recurrence. Interestingly, the relationship between HPV and improved survival appears to be specific to patients with low comorbidity at diagnosis.
KW - ACE-27
KW - Comorbidity
KW - Head and neck
KW - Human papillomavirus
KW - Oropharyngeal
KW - Squamous cell carcinoma
KW - Survival
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U2 - 10.1016/j.oraloncology.2013.07.001
DO - 10.1016/j.oraloncology.2013.07.001
M3 - Article
C2 - 23891528
AN - SCOPUS:84883133545
SN - 1368-8375
VL - 49
SP - 911
EP - 917
JO - Oral Oncology
JF - Oral Oncology
IS - 9
ER -
