Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands.
Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands.
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):793-801. doi: 10.1016/j.ijrobp.2017.02.214. Epub 2017 Mar 6.
We sought to assess the effect of age on overall survival (OS), cancer-specific survival (CSS), and non-cancer-related death (NCRD) in elderly (aged ≥70 years) head and neck squamous cell carcinoma (HNSCC) patients treated with definitive radiation therapy. The results were compared with those of younger patients, and the most important prognostic factors for survival endpoints were determined. Treatments may be better justified based on identification of the main differences in survival between young and elderly patients.
Data were analyzed from all consecutive HNSCC patients treated with definitive radiation therapy (66-70 Gy) in our department between April 2007 and December 2014. A total of 674 patients, including 168 elderly patients (24.9%), were included in the study. Multivariate association models were constructed to assess the effect of age on survival endpoints. Multivariate analysis was performed to identify potential prognostic factors for survival in elderly patients.
A total of 674 consecutive patients, including 168 elderly patients, were analyzed. The 5-year OS and NCRD rates were significantly worse for elderly patients than for young patients: 45.5% versus 58.2% (P=.007) and 39.0% versus 20.7% (P<.001), respectively. In the multivariate association analysis on the relationship between age and OS, lymph node involvement and worse World Health Organization (WHO) performance status were identified as significant confounders. Multivariate association analysis between age and NCRD identified Union for International Cancer Control stage as a significant confounder. After correction for confounders, the effect of age on OS and NCRD increased. Worse WHO performance status, lymph node involvement, and specific tumor site were independent prognostic factors for OS and CSS in the elderly patient group. Of the elderly patients, 80 (47%) died during follow-up; 45% of these deaths were ascribed to the index tumor. For elderly patients, radiation therapy combined with systemic forms of treatment was significantly associated with adverse NCRD rate (hazard ratio, 8.02; 95% confidence interval, 2.36-27.2; P=.001) after we performed a multivariate association analysis.
Elderly HNSCC patients have worse survival outcomes than young HNSCC patients. Age is an independent prognostic factor for OS, mainly due to an increase in non-cancer-related mortality and comorbid diseases. The differences in CSS between young and elderly patients are negligible.
我们旨在评估年龄对≥ 70 岁接受根治性放疗的老年头颈部鳞状细胞癌（HNSCC）患者的总生存（OS）、癌症特异性生存（CSS）和非癌症相关死亡（NCRD）的影响。将结果与年轻患者进行比较，并确定生存终点的最重要预后因素。基于对年轻和老年患者之间生存差异的识别，可能会更好地证明治疗的合理性。
我们分析了 2007 年 4 月至 2014 年 12 月期间在我科接受根治性放疗（66-70Gy）的所有连续 HNSCC 患者的数据。共有 674 例患者，包括 168 例老年患者（24.9%）纳入研究。构建多变量关联模型以评估年龄对生存终点的影响。进行多变量分析以确定老年患者生存的潜在预后因素。
共分析了 674 例连续患者，包括 168 例老年患者。老年患者的 5 年 OS 和 NCRD 率明显低于年轻患者：45.5%比 58.2%（P=.007）和 39.0%比 20.7%（P<.001）。在年龄与 OS 之间的多变量关联分析中，淋巴结受累和较差的世界卫生组织（WHO）表现状态被确定为显著的混杂因素。年龄与 NCRD 之间的多变量关联分析确定国际癌症控制联盟（UICC）分期为显著混杂因素。在纠正混杂因素后，年龄对 OS 和 NCRD 的影响增加。较差的 WHO 表现状态、淋巴结受累和特定肿瘤部位是老年患者 OS 和 CSS 的独立预后因素。在随访期间，168 例老年患者中有 80 例（47%）死亡；其中 45%的死亡归因于原发性肿瘤。对于老年患者，放疗联合全身治疗形式与不良 NCRD 发生率显著相关（风险比，8.02；95%置信区间，2.36-27.2；P=.001），我们进行了多变量关联分析后。
老年 HNSCC 患者的生存结果比年轻 HNSCC 患者差。年龄是 OS 的独立预后因素，主要是由于非癌症相关死亡率和合并症的增加。年轻和老年患者之间 CSS 的差异可以忽略不计。
