Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Oral Dis. 2018 Oct;24(7):1217-1225. doi: 10.1111/odi.12904. Epub 2018 Jun 28.
Patients with head and neck cancer (HNC) can die of index tumor progression and second tumor or non-cancer causes. Here, we investigated the risk factors for competing non-cancer mortality (NCM) in a prospective cohort of patients with advanced-stage HNC.
A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced-stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality (CM) defined as death from non-cancer causes and HNC or second cancers, respectively. Cumulative incidence and cause-specific hazard functions were used to analyze the risk factors of NCM and CM.
Age, smoking, Charlson comorbidity index (CCI), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all p < 0.05). Multivariate analyses showed that age, CCI, and hemoglobin were independent factors of NCM. Age (≥65 years), CCI (≥2), and hemoglobin (<11 g/dl) were related to 4.5-, 3.2-, and 2.7-fold increased adjusted risk of NCM, respectively.
Old age, comorbidity, and hemoglobin at diagnosis were independent predictors of NCM. The risk factors could be used to predict non-cancer death after definitive treatment for advanced-stage HNC.
头颈部癌症（HNC）患者可能因肿瘤进展和第二肿瘤或非癌症原因而死亡。在此，我们研究了前瞻性队列中晚期 HNC 患者发生竞争非癌症死亡率（NCM）的风险因素。
对 2010 年至 2015 年间接受晚期 HNC 确定性治疗的 604 例患者进行了前瞻性观察性研究。主要结局是 NCM 和癌症死亡率（CM），分别定义为非癌症原因和 HNC 或第二癌症导致的死亡。累积发生率和特定原因的危险函数用于分析 NCM 和 CM 的风险因素。
年龄、吸烟、Charlson 合并症指数（CCI）、表现状态、体重指数、农村居住、教育和诊断时的血红蛋白水平以及化疗与 NCM 显著相关（均 p<0.05）。多变量分析显示，年龄、CCI 和血红蛋白是 NCM 的独立因素。年龄（≥65 岁）、CCI（≥2）和血红蛋白（<11 g/dl）与调整后的 NCM 风险分别增加 4.5、3.2 和 2.7 倍相关。
年龄较大、合并症和诊断时的血红蛋白是 NCM 的独立预测因素。这些危险因素可用于预测晚期 HNC 确定性治疗后的非癌症死亡。
