Non-cancer health events as a leading cause of competing mortality in advanced head and neck cancer
Menée en Corée auprès de 600 patients atteints d'un cancer de la tête et du cou de stade avancé, cette étude de cohorte analyse les morbidités non liées au cancer ainsi que la mortalité par autres causes que le cancer
Background : The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected by non-cancer health events (NCHE) as well as by index cancer progression and second primary cancer (SPC). This study aimed to investigate the risk factors for NCHE and non-cancer mortality (NCM) in patients with advanced-stage HNSCC. Patients and methods : This cohort study involved 600 consecutive patients with overall stage III to IV HNSCC who were treated between 2001 and 2010 at our tertiary referral hospital. NCHE was defined as re-admission (i.e., after the primary treatments for the index tumors) due to non-cancer-related causes. The incidences of NCHE and NCM and their risk factors were analyzed by using cumulative incidence and cause-specific hazard functions. Results : During a median follow-up period of 54 months, 224 (37.3%) and 55 (9.2%) of the 600 patients had NCHE and NCM, respectively. The five-year index cancer-, SPC-, and non-cancer-mortality rates were 23.8%, 4.2%, and 8.9%, respectively. Multivariate analyses revealed that body mass index<20 kg/m2 (P=0.018), Charlson comorbidity index (CCI)≥1 (P<0.001), tumor recurrence (P<0.001), SPC occurrence (P<0.001), and initial chemotherapy (P=0.049) were independent NCHE predictors. Older age (P<0.001), CCI≥1 (P=0.008), tumor recurrence (P<0.001), and SPC occurrence (P=0.047) were independent NCM predictors. Patients with respiratory NCHE were at a higher risk of NCM than patients with other NCHE types (P<0.001). Conclusions : One or more comorbidities, tumor recurrence, and SPC occurrence were independent predictors of both NCHE and NCM. Patients with respiratory NCHE had a particularly high risk of NCM.