Verschuur H P, Irish J C, O'Sullivan B, Goh C, Gullane P J, Pintilie M
Department of Otolaryngology, The Toronto Hospital, University of Toronto, Ontario, Canada.
Laryngoscope. 1999 Feb;109(2 Pt 1):249-58. doi: 10.1097/00005537-199902000-00015.
OBJECTIVES/HYPOTHESIS: To determine if there is a difference in overall survival, cause-specific survival, and relapse-free rate between young patients (<40 years of age) with head and neck squamous cell carcinoma (HNSCC) and older patients (>40 years of age).
A matched control study describing the outcome of 185 previously untreated HNSCC patients less than 40 years of age treated at the Princess Margaret Hospital, Toronto, Ontario, Canada, between 1958 and 1992. The young patient group was compared with a control group of older patients (> 40 years of age) which was selected randomly from an entire cohort of patients (n = 10,072) and matched for site, sex, and date of presentation.
The medical records were reviewed and data abstracted for demographic information, tobacco and alcohol use, family history, primary site, clinical stage, primary treatment, histology, the occurrence of residual or recurrent disease, salvage treatment, development of subsequent primaries, survival, and the eventual cause of death. The patient's TNM stage was reclassified according to American Joint Cancer Committee/Union Internationale Contre le Cancer (AJCC/UICC) 1992 criteria on the basis of the initial clinical description and staging investigations. A multivariate regression analysis was performed. To assess the importance of age as a prognostic factor for survival, the Cox proportion hazard model was used. Smoking status was also tested in the stratified Cox proportional hazard model.
Tumor stage and treatment modalities were comparable in both groups. The 5-year, cause-specific survival in both groups was not statistically different (72% vs. 68%, P = .91). The young patient group had a significantly better 5-year overall survival compared with the older patient group (68% vs. 49%, P = .0011). Older patients developed more subsequent primary neoplasms than the younger patient population (18% vs. 8%, P = .005). There were significantly more females, an increased incidence of oral or oropharyngeal cancer, and fewer smokers in the young patient group. Smoking, however, had an important impact on outcome with all but one patient who developed a second primary in the upper aerodigestive tract having smoked. Multivariate analysis showed that only disease stage and cancer site were significant prognostic factors for survival.
Young patients with HNSCC do not have a worse prognosis than a matched older patient group in this case-controlled study (power > 0.75 for a minimal detectable difference of 10% disease-free survival between the two groups).
目的/假设：确定年龄小于40岁的头颈部鳞状细胞癌（HNSCC）年轻患者与年龄大于40岁的老年患者在总生存率、特定病因生存率和无复发生存率方面是否存在差异。
一项匹配对照研究，描述了1958年至1992年期间在加拿大多伦多玛格丽特公主医院接受治疗的185例年龄小于40岁、未经治疗的HNSCC患者的结局。将年轻患者组与从整个患者队列（n = 10,072）中随机选取的年龄大于40岁的老年患者对照组进行比较，并根据部位、性别和就诊日期进行匹配。
查阅病历并提取人口统计学信息、烟草和酒精使用情况、家族史、原发部位、临床分期、初始治疗、组织学、残留或复发性疾病的发生情况、挽救治疗、后续原发性肿瘤的发生、生存情况以及最终死亡原因等数据。根据美国癌症联合委员会/国际抗癌联盟（AJCC/UICC）1992年标准，基于初始临床描述和分期检查对患者的TNM分期进行重新分类。进行多因素回归分析。为评估年龄作为生存预后因素的重要性，使用Cox比例风险模型。在分层Cox比例风险模型中也对吸烟状态进行了检验。
两组的肿瘤分期和治疗方式具有可比性。两组的5年特定病因生存率无统计学差异（72%对68%，P = 0.91）。年轻患者组的5年总生存率显著高于老年患者组（68%对49%，P = 0.0011）。老年患者发生后续原发性肿瘤的比例高于年轻患者群体（18%对8%，P = 0.005）。年轻患者组女性更多，口腔或口咽癌发病率增加，吸烟者较少。然而，吸烟对结局有重要影响，除1例患者外，所有在上呼吸道消化道发生第二原发性肿瘤的患者均有吸烟史。多因素分析表明，只有疾病分期和癌症部位是生存的重要预后因素。
在这项病例对照研究中，HNSCC年轻患者的预后并不比匹配的老年患者组差（两组无病生存率最小可检测差异为10%时的检验效能>0.75）。
