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Abstract

The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected not only by progression of the original cancer or occurrence of a second cancer but also by noncancer health event (NCHE). In this study, we evaluated the prognostic significance of early NCHEs in HNSCC patients after definitive radiotherapy (RT) or chemoradiotherapy (CRT).The prospective study cohort comprised 190 HNSCC patients who underwent definitive RT (n = 75) or CRT (n = 115). An early NCHE was defined as an event requiring hospital readmission of the patient within 12 months after treatment. Univariate and multivariate analyses were performed to identify clinicopathologic factors associated with early NCHEs, and competing and all-cause mortalities.Thirty-three patients suffered an NCHE (17.3%) and 8 succumbed to a competing cause of mortality (4.2%). Twenty-two (11.6%) patients had an early NCHE: respiratory (22.8%), cerebrovascular (13.7%), gastrointestinal (13.7%), and others (50.0%). In multivariate analysis, hypoalbuminemia (P = 0.022, hazard ratio [HR] = 3.66, 95% confidence interval [CI] = 1.21-11.1), chemotherapy (P = 0.047, HR = 3.02, 95% CI = 1.01-8.98), and tumor recurrence (P = 0.024, HR = 2.66, 95% CI = 1.14-6.22) were independent predictors of an early NCHE. Patients with early NCHEs were at high risk of competing mortality (P < 0.001, HR = 22.6, 95% CI = 4.21-121.00) and all-cause mortality (P = 0.002, HR = 4.44, 95% CI = 1.76-11.2).Early NCHEs are a major contributor to competing and all-cause mortality in HNSCC patients receiving RT or CRT. The risk factors identified could be used to predict early NCHEs. 

Author information

Kang HS1, Roh JL, Lee SW, Kim SB, Choi SH, Nam SY, Kim SY.​

1From the Departments of Otolaryngology (H-SK, J-LR, S-HC, SYN, SYK); Radiation Oncology and (S-WL); and Internal Medicine (Oncology) (S-BK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.