Comorbidity, human papillomavirus infection and head and neck cancer survival in an ethnically diverse population

Ashish A. Ankola, Richard V. Smith, Robert D. Burk, Michael B. Prystowsky, Catherine Sarta, Nicolas F. Schlecht

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)911-917
Number of pages7
JournalOral Oncology
Volume49
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Papillomavirus Infections
Head and Neck Neoplasms
Comorbidity
Survival
Population
Neoplasms
Oropharyngeal Neoplasms
Recurrence
Mouth Neoplasms
Kaplan-Meier Estimate
Street Drugs
Survival Analysis
Medical Records
Mouth
Diabetes Mellitus

Keywords

  • ACE-27
  • Comorbidity
  • Head and neck
  • Human papillomavirus
  • Oropharyngeal
  • Squamous cell carcinoma
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Oral Surgery
  • Cancer Research

Cite this

Comorbidity, human papillomavirus infection and head and neck cancer survival in an ethnically diverse population. / Ankola, Ashish A.; Smith, Richard V.; Burk, Robert D.; Prystowsky, Michael B.; Sarta, Catherine; Schlecht, Nicolas F.

In: Oral Oncology, Vol. 49, No. 9, 09.2013, p. 911-917.

Research output: Contribution to journalArticle

@article{fc8da462b14646278056b1bbd8b7aba9,
title = "Comorbidity, human papillomavirus infection and head and neck cancer survival in an ethnically diverse population",
abstract = "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.",
keywords = "ACE-27, Comorbidity, Head and neck, Human papillomavirus, Oropharyngeal, Squamous cell carcinoma, Survival",
author = "Ankola, {Ashish A.} and Smith, {Richard V.} and Burk, {Robert D.} and Prystowsky, {Michael B.} and Catherine Sarta and Schlecht, {Nicolas F.}",
year = "2013",
month = "9",
doi = "10.1016/j.oraloncology.2013.07.001",
language = "English (US)",
volume = "49",
pages = "911--917",
journal = "Oral Oncology",
issn = "1368-8375",
publisher = "Elsevier Limited",
number = "9",

}

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.

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

UR - http://www.scopus.com/inward/record.url?scp=84883133545&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84883133545&partnerID=8YFLogxK

U2 - 10.1016/j.oraloncology.2013.07.001

DO - 10.1016/j.oraloncology.2013.07.001

M3 - Article

VL - 49

SP - 911

EP - 917

JO - Oral Oncology

JF - Oral Oncology

SN - 1368-8375

IS - 9

ER -