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Erschienen in: Annals of Surgical Oncology 4/2007

01.04.2007

Comorbidity Is a Prognostic Factor in Elderly Patients with Head and Neck Cancer

verfasst von: Alvaro Sanabria, MD, MSc, André Lopes Carvalho, MD, PhD, José Guilherme Vartanian, MD, José Magrin, MD, PhD, Mauro Kasuo Ikeda, MD, PhD, Luiz Paulo Kowalski, MD, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 4/2007

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Abstract

Background

The number of aged patients with head and neck cancer is increasing. Comorbidities are common in this population. It is necessary to evaluate the effect of comorbidities as measured with the ACE-27 index on recurrence and survival of elderly patients with head and neck cancer, adjusting by other prognostic factors as age, clinical stage and functional status index.

Patients

Three hundred and ten patients greater than 70 years of age with head and neck cancer in a referral cancer center were studied. Comorbidity measured with the ACE-27 index was the main independent variable. The outcomes were recurrence and survival.

Results

Comorbidities were present in 75% of patients. Five-year disease-free survival, overall survival and cancer-specific survival were 63.1, 42.8 and 55.8%, respectively. Advanced clinical stage and Karnofsky index ≤70 were associated with recurrence. Age >80 years, male gender, Karnofsky index ≤80, advanced clinical stage, and ACE value ≥2 were independently associated with overall survival. The ACE-27 value was not associated with cancer-specific survival. The Karnofsky performance index was associated with overall survival and mortality and acted as a confounding factor on multivariable analysis on overall and cancer-specific survival.

Conclusions

Comorbidity measured with ACE-27 was a prognostic factor for overall survival in patients older than 70 years with head and neck cancer. The Karnofsky performance index could be included in multivariable analysis of survival for older patients with head and neck cancer.
Literatur
1.
2.
Zurück zum Zitat Franceschi S, Bidoli E, Negri E, Barbone F, La VC. Alcohol and cancers of the upper aerodigestive tract in men and women. Cancer Epidemiol Biomarkers Prev 1994; 3:299–304PubMed Franceschi S, Bidoli E, Negri E, Barbone F, La VC. Alcohol and cancers of the upper aerodigestive tract in men and women. Cancer Epidemiol Biomarkers Prev 1994; 3:299–304PubMed
3.
Zurück zum Zitat Verschuur HP, Irish JC, O’Sullivan B, Goh C, Gullane PJ, Pintilie M. A matched control study of treatment outcome in young patients with squamous cell carcinoma of the head and neck. Laryngoscope 1999; 109:249–58PubMedCrossRef Verschuur HP, Irish JC, O’Sullivan B, Goh C, Gullane PJ, Pintilie M. A matched control study of treatment outcome in young patients with squamous cell carcinoma of the head and neck. Laryngoscope 1999; 109:249–58PubMedCrossRef
4.
Zurück zum Zitat Boruk M, Chernobilsky B, Rosenfeld RM, Har-El G. Age as a prognostic factor for complications of major head and neck surgery. Arch Otolaryngol Head Neck Surg 2005; 131:605–9PubMedCrossRef Boruk M, Chernobilsky B, Rosenfeld RM, Har-El G. Age as a prognostic factor for complications of major head and neck surgery. Arch Otolaryngol Head Neck Surg 2005; 131:605–9PubMedCrossRef
5.
Zurück zum Zitat Kowalski LP, Alcantara PS, Magrin J, Parise JO. A case-control study on complications and survival in elderly patients undergoing major head and neck surgery. Am J Surg 1994; 168:485–90PubMedCrossRef Kowalski LP, Alcantara PS, Magrin J, Parise JO. A case-control study on complications and survival in elderly patients undergoing major head and neck surgery. Am J Surg 1994; 168:485–90PubMedCrossRef
6.
Zurück zum Zitat Piccirillo JF, Lacy PD, Basu A, Spitznagel EL. Development of a new head and neck cancer-specific comorbidity index. Arch Otolaryngol Head Neck Surg 2002; 128:1172–9PubMed Piccirillo JF, Lacy PD, Basu A, Spitznagel EL. Development of a new head and neck cancer-specific comorbidity index. Arch Otolaryngol Head Neck Surg 2002; 128:1172–9PubMed
7.
Zurück zum Zitat Hall SF, Rochon PA, Streiner DL, Paszat LF, Groome PA, Rohland SL. Measuring comorbidity in patients with head and neck cancer. Laryngoscope 2002; 112:1988–96PubMedCrossRef Hall SF, Rochon PA, Streiner DL, Paszat LF, Groome PA, Rohland SL. Measuring comorbidity in patients with head and neck cancer. Laryngoscope 2002; 112:1988–96PubMedCrossRef
8.
Zurück zum Zitat Piccirillo JF. Importance of comorbidity in head and neck cancer. Laryngoscope 2000; 110:593–602PubMedCrossRef Piccirillo JF. Importance of comorbidity in head and neck cancer. Laryngoscope 2000; 110:593–602PubMedCrossRef
9.
Zurück zum Zitat Derks W, De L Jr, Hordijk GJ, Winnubst JA. Reasons for non-standard treatment in elderly patients with advanced head and neck cancer. Eur Arch Otorhinolaryngol 2005; 262:21–6PubMedCrossRef Derks W, De L Jr, Hordijk GJ, Winnubst JA. Reasons for non-standard treatment in elderly patients with advanced head and neck cancer. Eur Arch Otorhinolaryngol 2005; 262:21–6PubMedCrossRef
10.
Zurück zum Zitat Havlik RJ, Yancik R, Long S, Ries L, Edwards B. The National Institute on Aging and the National Cancer Institute SEER collaborative study on comorbidity and early diagnosis of cancer in the elderly. Cancer 1994; 74:2101–6PubMedCrossRef Havlik RJ, Yancik R, Long S, Ries L, Edwards B. The National Institute on Aging and the National Cancer Institute SEER collaborative study on comorbidity and early diagnosis of cancer in the elderly. Cancer 1994; 74:2101–6PubMedCrossRef
11.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40:373–383PubMedCrossRef
12.
Zurück zum Zitat Rogers SN, Aziz A, Lowe D, Husband DJ. Feasibility study of the retrospective use of the Adult Comorbidity Evaluation index (ACE-27) in patients with cancer of the head and neck who had radiotherapy. Br J Oral Maxillofac Surg 2005; 43(6):511–2CrossRef Rogers SN, Aziz A, Lowe D, Husband DJ. Feasibility study of the retrospective use of the Adult Comorbidity Evaluation index (ACE-27) in patients with cancer of the head and neck who had radiotherapy. Br J Oral Maxillofac Surg 2005; 43(6):511–2CrossRef
13.
Zurück zum Zitat Paleri V, Wight RG. Applicability of the adult comorbidity evaluation—27 and the Charlson indexes to assess comorbidity by notes extraction in a cohort of United Kingdom patients with head and neck cancer: a retrospective study. J Laryngol Otol 2002; 116:200–5PubMedCrossRef Paleri V, Wight RG. Applicability of the adult comorbidity evaluation—27 and the Charlson indexes to assess comorbidity by notes extraction in a cohort of United Kingdom patients with head and neck cancer: a retrospective study. J Laryngol Otol 2002; 116:200–5PubMedCrossRef
14.
Zurück zum Zitat Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004; 291:2441–7PubMedCrossRef Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004; 291:2441–7PubMedCrossRef
15.
Zurück zum Zitat Lachin JM. Introduction to sample size determination and power analysis for clinical trials. Control Clin Trials 1981; 2:93–113PubMedCrossRef Lachin JM. Introduction to sample size determination and power analysis for clinical trials. Control Clin Trials 1981; 2:93–113PubMedCrossRef
16.
Zurück zum Zitat Faye-Lund H, Abdelnoor M. Prognostic factors of survival in a cohort of head, neck cancer patients in Oslo. Eur J Cancer B Oral Oncol 1996; 32B:83–90PubMedCrossRef Faye-Lund H, Abdelnoor M. Prognostic factors of survival in a cohort of head, neck cancer patients in Oslo. Eur J Cancer B Oral Oncol 1996; 32B:83–90PubMedCrossRef
17.
Zurück zum Zitat Magnano M, De SA, Usai A, et al. Carcinoma of the larynx in the elderly: analysis of potentially significant prognostic variables. Aging (Milano) 1999; 11:316–22 Magnano M, De SA, Usai A, et al. Carcinoma of the larynx in the elderly: analysis of potentially significant prognostic variables. Aging (Milano) 1999; 11:316–22
18.
Zurück zum Zitat Bliss R, Patel N, Guinea A, Reeve TS, Delbridge L. Age is no contraindication to thyroid surgery. Age Ageing 1999; 28:363–6PubMedCrossRef Bliss R, Patel N, Guinea A, Reeve TS, Delbridge L. Age is no contraindication to thyroid surgery. Age Ageing 1999; 28:363–6PubMedCrossRef
19.
Zurück zum Zitat Hirano M, Mori K. Management of cancer in the elderly: therapeutic dilemmas. Otolaryngol Head Neck Surg 1998; 118:110–4PubMedCrossRef Hirano M, Mori K. Management of cancer in the elderly: therapeutic dilemmas. Otolaryngol Head Neck Surg 1998; 118:110–4PubMedCrossRef
20.
Zurück zum Zitat Derks W, De L Jr, Hordijk GJ, Winnubst JA. Elderly patients with head and neck cancer: short-term effects of surgical treatment on quality of life. Clin Otolaryngol Allied Sci 2003; 28:399–405PubMedCrossRef Derks W, De L Jr, Hordijk GJ, Winnubst JA. Elderly patients with head and neck cancer: short-term effects of surgical treatment on quality of life. Clin Otolaryngol Allied Sci 2003; 28:399–405PubMedCrossRef
21.
Zurück zum Zitat de Cassia Braga RK, Kowalski LP, Latorre MR. Perioperative complications, comorbidities, and survival in oral or oropharyngeal cancer. Arch Otolaryngol Head Neck Surg 2003; 129:219–28 de Cassia Braga RK, Kowalski LP, Latorre MR. Perioperative complications, comorbidities, and survival in oral or oropharyngeal cancer. Arch Otolaryngol Head Neck Surg 2003; 129:219–28
22.
Zurück zum Zitat Yates JW. Comorbidity considerations in geriatric oncology research. CA Cancer J Clin 2001; 51:329–36PubMed Yates JW. Comorbidity considerations in geriatric oncology research. CA Cancer J Clin 2001; 51:329–36PubMed
23.
Zurück zum Zitat Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluatin the outcome of diabetes mellitus. J Chronic Dis 1974; 27:387–404PubMedCrossRef Kaplan MH, Feinstein AR. The importance of classifying initial co-morbidity in evaluatin the outcome of diabetes mellitus. J Chronic Dis 1974; 27:387–404PubMedCrossRef
24.
Zurück zum Zitat Singh B, Bhaya M, Stern J, et al. Validation of the Charlson comorbidity index in patients with head and neck cancer: a multi-institutional study. Laryngoscope 1997; 107:1469–75PubMedCrossRef Singh B, Bhaya M, Stern J, et al. Validation of the Charlson comorbidity index in patients with head and neck cancer: a multi-institutional study. Laryngoscope 1997; 107:1469–75PubMedCrossRef
25.
Zurück zum Zitat Borggreven PA, Kuik DJ, Quak JJ, de BR, Snow GB, Leemans CR. Comorbid condition as a prognostic factor for complications in major surgery of the oral cavity and oropharynx with microvascular soft tissue reconstruction. Head Neck 2003; 25:808–15PubMedCrossRef Borggreven PA, Kuik DJ, Quak JJ, de BR, Snow GB, Leemans CR. Comorbid condition as a prognostic factor for complications in major surgery of the oral cavity and oropharynx with microvascular soft tissue reconstruction. Head Neck 2003; 25:808–15PubMedCrossRef
26.
Zurück zum Zitat Paleri V, Narayan R, Wight RG. Descriptive study of the type and severity of decompensation caused by comorbidity in a population of patients with laryngeal squamous cancer. J Laryngol Otol 2004; 118:517–21PubMedCrossRef Paleri V, Narayan R, Wight RG. Descriptive study of the type and severity of decompensation caused by comorbidity in a population of patients with laryngeal squamous cancer. J Laryngol Otol 2004; 118:517–21PubMedCrossRef
27.
Zurück zum Zitat Ferrier MB, Spuesens EB, Le CS, Baatenburg de Jong RJ. Comorbidity as a major risk factor for mortality and complications in head and neck surgery. Arch Otolaryngol Head Neck Surg 2005; 131:27–32PubMedCrossRef Ferrier MB, Spuesens EB, Le CS, Baatenburg de Jong RJ. Comorbidity as a major risk factor for mortality and complications in head and neck surgery. Arch Otolaryngol Head Neck Surg 2005; 131:27–32PubMedCrossRef
28.
Zurück zum Zitat Piccirillo JF, Spitznagel EL Jr, Vermani N, Costas I, Schnitzler M. Comparison of comorbidity indices for patients with head and neck cancer. Med Care 2004; 42:482–6PubMedCrossRef Piccirillo JF, Spitznagel EL Jr, Vermani N, Costas I, Schnitzler M. Comparison of comorbidity indices for patients with head and neck cancer. Med Care 2004; 42:482–6PubMedCrossRef
29.
Zurück zum Zitat Sesterhenn AM, Teymoortash A, Folz BJ, Werner JA. Head and neck cancer in the elderly: a cohort study in 40 patients. Acta Oncol 2005; 44:59–64PubMedCrossRef Sesterhenn AM, Teymoortash A, Folz BJ, Werner JA. Head and neck cancer in the elderly: a cohort study in 40 patients. Acta Oncol 2005; 44:59–64PubMedCrossRef
30.
Zurück zum Zitat Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994; 120:104–10PubMed Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994; 120:104–10PubMed
31.
Zurück zum Zitat Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol 2004; 22:3099–103PubMedCrossRef Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol 2004; 22:3099–103PubMedCrossRef
32.
Zurück zum Zitat Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 1998; 16:1582–7PubMed Extermann M, Overcash J, Lyman GH, Parr J, Balducci L. Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 1998; 16:1582–7PubMed
33.
Zurück zum Zitat Artz AS, Pollyea DA, Kocherginsky M, et al. Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2006; 12:954–64PubMedCrossRef Artz AS, Pollyea DA, Kocherginsky M, et al. Performance status and comorbidity predict transplant-related mortality after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2006; 12:954–64PubMedCrossRef
34.
Zurück zum Zitat Firat S, Byhardt RW, Gore E. Comorbidity and Karnofksy performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of patients treated on four RTOG studies. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 2002; 54:357–64PubMedCrossRef Firat S, Byhardt RW, Gore E. Comorbidity and Karnofksy performance score are independent prognostic factors in stage III non-small-cell lung cancer: an institutional analysis of patients treated on four RTOG studies. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 2002; 54:357–64PubMedCrossRef
35.
Zurück zum Zitat Firat S, Bousamra M, Gore E, Byhardt RW. Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002; 52:1047–57PubMedCrossRef Firat S, Bousamra M, Gore E, Byhardt RW. Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002; 52:1047–57PubMedCrossRef
36.
Zurück zum Zitat Ingram SS, Seo PH, Martell RE, et al. Comprehensive assessment of the elderly cancer patient: the feasibility of self-report methodology. J Clin Oncol 2002; 20:770–5PubMedCrossRef Ingram SS, Seo PH, Martell RE, et al. Comprehensive assessment of the elderly cancer patient: the feasibility of self-report methodology. J Clin Oncol 2002; 20:770–5PubMedCrossRef
37.
Zurück zum Zitat Repetto L, Venturino A, Fratino L, et al. Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer 2003; 39:870–80PubMedCrossRef Repetto L, Venturino A, Fratino L, et al. Geriatric oncology: a clinical approach to the older patient with cancer. Eur J Cancer 2003; 39:870–80PubMedCrossRef
38.
Zurück zum Zitat Friedrich C, Kolb G, Wedding U, Pientka L. Comprehensive geriatric assessment in the elderly cancer patient. Onkologie 2003; 26:355–60PubMedCrossRef Friedrich C, Kolb G, Wedding U, Pientka L. Comprehensive geriatric assessment in the elderly cancer patient. Onkologie 2003; 26:355–60PubMedCrossRef
39.
Zurück zum Zitat Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 2002; 20:494–502PubMedCrossRef Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study. J Clin Oncol 2002; 20:494–502PubMedCrossRef
Metadaten
Titel
Comorbidity Is a Prognostic Factor in Elderly Patients with Head and Neck Cancer
verfasst von
Alvaro Sanabria, MD, MSc
André Lopes Carvalho, MD, PhD
José Guilherme Vartanian, MD
José Magrin, MD, PhD
Mauro Kasuo Ikeda, MD, PhD
Luiz Paulo Kowalski, MD, PhD
Publikationsdatum
01.04.2007
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 4/2007
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-006-9296-1

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