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Head and Neck Cancer Mortality Predicted By Increased Pathologic Upstaging


A new method of measuring tumor progression offers prognostic implications for patients with head and neck squamous cell carcinoma experiencing treatment delays.

The initial time to treatment is increasing in head and neck squamous cell carcinoma, which has been associated with worsening survival.

A recent study led by Brian B Burkey, MD, section of head and neck surgery and oncology, Head and Neck Institute, Cleveland Clinic (OH), aimed at identifying a mechanism for the relationship between increased time to treatment initiation and survival. Researchers assessed the effects of time to treatment initiation on clinical-to-pathologic upstaging in patients with head and neck squamous cell carcinoma. Using the National Cancer Data Base, researchers sampled patients receiving definitive surgery for squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx from 2005 through 2014.

The primary outcomes were T, N, or stage group upstaging, which was predefined as higher pathologic stage than clinical stage. Time to treatment initiation was defined as the time between diagnosis and surgery.

Results of the study were published in Cancer (online January 9, 2018; doi:10.1002/cncr.31213).

For analysis of T, N, and stage group data, researchers enrolled 60,194 patients, 51,380 patients, and 52,980 patients, respectively, with available data. Among these cohorts, N upstaging was reportedly the most common (18.6%), followed by stage group (17.4%) and T (12.1%) upstaging. All three types were predicted by time to treatment initiation.

Researchers noted that times to treatment initiation as short as 7 to 13 days (OR, 1.20; P = .038) or at least 70 days (OR, 2.04; P < .001) were predictive of T upstaging, compared with a time to treatment initiation of 1 to 6 days. This finding, they wrote, was consistent for N and stage group upstaging. The relative odds of T and stage group upstaging increased to 2.25 and 1.93, respectively, at a time of treatment initiation of 365 days.

Further survival analyses showed that T, N, and stage group upstaging all were predictive of mortality (P < .001), while time to treatment initiation only predicted mortality after 70 days (P = .023).

In their concluding section, Dr Burkey and colleagues wrote that “Tumor progression, measured by clinical-to-pathologic upstaging, increases mortality for patients with head and neck squamous cell carcinoma experiencing treatment delays.”—Zachary Bessette