Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
Int J Radiat Oncol Biol Phys. 2017 Jul 15;98(4):775-783. doi: 10.1016/j.ijrobp.2017.03.017. Epub 2017 Mar 18.
Oral cavity squamous cell carcinoma (OCSCC) commonly occurs in elderly patients. This study explores the clinical outcomes in elderly patients with OCSCC based on their functional status and clinical comorbidities.
We retrospectively reviewed 180 patients aged ≥70 who were treated with definitive intent with surgery followed by adjuvant therapy if indicated for newly diagnosed OCSCC from 1998 to 2013. Pathology review was conducted, and Eastern Cooperative Oncology Group (ECOG) performance status and the Head and Neck Charlson Comorbidity Index (HN-CCI) were assessed. We performed Kaplan-Meier analyses and cumulative incidence estimates to assess overall survival (OS), progression-free survival (PFS), and locoregional recurrence (LRR). Univariate and multivariate analyses were used to test age, adjuvant therapy, adverse pathologic features, ECOG status, and HN-CCI status as predictors.
The median age was 80 years (range, 70-95 years), with a median follow-up time of 23 months. The median OS was 18 months and 46 months for patients aged 70 to 84 and ≥85, respectively (P=.0017). The LRR was 24% at 1 year and 30% at 2 years for all patients. On univariate analysis, ECOG score ≥2 (hazard ratio [HR] = 1.96; confidence interval [CI] 1.19-3.21; P=.008) and HN-CCI score ≥2 (HR=1.97; CI 1.17-3.34; P=.011) were predictors of worse OS. On multivariate analysis, HN-CCI score was a better predictor of OS, PFS, and LRR than was ECOG score. Predictors of worse OS were age ≥85 (HR=1.78; CI 1.07-2.96; P=.026), HN-CCI score of ≥2 (HR=2.21; CI 1.20-4.08; P=.011), and adverse features (HR=2.35; CI 1.34-4.13; P=.003). Adjuvant therapy did not have a significant impact on OS or LRR for patients with adverse features even though 48% of them did not receive it.
Elderly patients with good health and performance status may live long enough to experience disease progression from OCSCC. ECOG and HN-CCI scores may be useful to evaluate the candidacy of elderly patients for adjuvant therapy. However, the benefit of adjuvant therapy in this population remains elusive and should be investigated prospectively.
口腔鳞状细胞癌（OCSCC）常见于老年患者。本研究基于功能状态和临床合并症，探讨老年 OCSCC 患者的临床结局。
我们回顾性分析了 1998 年至 2013 年间接受根治性手术治疗并根据需要接受辅助治疗的 180 名年龄≥70 岁的新诊断为 OCSCC 的患者。进行了病理学检查，并评估了东部合作肿瘤学组（ECOG）表现状态和头颈部 Charlson 合并症指数（HN-CCI）。我们进行了 Kaplan-Meier 分析和累积发生率估计，以评估总生存期（OS）、无进展生存期（PFS）和局部区域复发（LRR）。使用单变量和多变量分析测试年龄、辅助治疗、不良病理特征、ECOG 状态和 HN-CCI 状态作为预测因素。
中位年龄为 80 岁（范围 70-95 岁），中位随访时间为 23 个月。70-84 岁和≥85 岁的患者中位 OS 分别为 18 个月和 46 个月（P=.0017）。所有患者的 1 年 LRR 为 24%，2 年 LRR 为 30%。单变量分析显示，ECOG 评分≥2（风险比[HR] = 1.96；置信区间[CI] 1.19-3.21；P=.008）和 HN-CCI 评分≥2（HR=1.97；CI 1.17-3.34；P=.011）是 OS 的预测因素。多变量分析显示，HN-CCI 评分比 ECOG 评分更能预测 OS、PFS 和 LRR。OS 的不良预测因素包括年龄≥85 岁（HR=1.78；CI 1.07-2.96；P=.026）、HN-CCI 评分≥2（HR=2.21；CI 1.20-4.08；P=.011）和不良特征（HR=2.35；CI 1.34-4.13；P=.003）。尽管 48%的患者未接受辅助治疗，但对于有不良特征的患者，辅助治疗对 OS 或 LRR 没有显著影响。
健康状况和表现状态良好的老年患者可能会活得足够长，从而经历 OCSCC 的疾病进展。ECOG 和 HN-CCI 评分可能有助于评估老年患者接受辅助治疗的资格。然而，该人群中辅助治疗的获益仍不明确，应进行前瞻性研究。
