Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Shanghai, China.
Int J Clin Pract. 2021 May;75(5):e14059. doi: 10.1111/ijcp.14059. Epub 2021 Feb 26.
The objective of this study is to assess the clinical manifestations and prognostic value of age on overall survival (OS) and cancer-specific survival (CSS) for hypopharynx squamous cell carcinoma (SCC) using the Surveillance, Epidemiology and End Results (SEER) database.
Patients with hypopharynx SCC were extracted from the SEER database between 2004 and 2014. We examined the clinicopathological variables using Chi-squared tests and we evaluated the association between survival and different variables, including age, race, grade, tumour location, T category, N category and surgery therapies to the primary tumour, using the methods of Kaplan-Meier. Univariate and multivariate analyses were performed to determine the effects of each variable on survival.
A total of 3702 patients were analysed. The patients aged 25-49 tended to be black and present withN3 and stage IV (P <.01). In multivariate analyses, the patients aged 25-39 had better survival rates, and the risk of death became higher with increasing age. Compared with patients aged 25 to 39 years, the hazard ratios for patients aged 40-49, 50-59, 60-69, 70-79 and 80-95 years were 1.190 (95% confidence interval [CI] 0.584-2.423), 1.156 (95% CI 0.575-2.324), 1.315 (95% CI 0.654-2.642), 1.780 (95% CI 0.884-3.584) and 2.614 (95% CI 1.292-5.288) respectively. Subgroups analysis shows that the effect of advancing age was significantly associated with a higher risk of poor survival in patients who harboured moderately/poorly differentiated (all P <.05), T1-T4a, N0-N2b or stage I-IVa disease (all P <.05, respectively).
Younger patients tended to present with advanced N classification. Increasing age at diagnosis was associated with a significantly higher risk of poorer OS. However, when considering patients affected by more aggressive disease, age was not significantly associated with higher risk of dying from hypopharynx SCC. In high-risk patients, tumour characteristics rather than age should be considered when making treatment decisions.
本研究旨在利用监测、流行病学和最终结果（SEER）数据库评估年龄对下咽鳞状细胞癌（SCC）总生存（OS）和癌症特异性生存（CSS）的临床表型和预后价值。
本研究从 2004 年至 2014 年的 SEER 数据库中提取下咽 SCC 患者。我们使用卡方检验检查临床病理变量，并使用 Kaplan-Meier 方法评估生存与不同变量之间的关系，包括年龄、种族、分级、肿瘤位置、T 分期、N 分期和手术治疗原发肿瘤。进行单变量和多变量分析以确定每个变量对生存的影响。
共分析了 3702 例患者。25-49 岁的患者倾向于为黑人，且表现为 N3 和 IV 期（P<.01）。在多变量分析中，25-39 岁的患者生存率较好，年龄越大，死亡风险越高。与 25 至 39 岁的患者相比，40-49 岁、50-59 岁、60-69 岁、70-79 岁和 80-95 岁的患者的危险比分别为 1.190（95%置信区间 [CI] 0.584-2.423）、1.156（95% CI 0.575-2.324）、1.315（95% CI 0.654-2.642）、1.780（95% CI 0.884-3.584）和 2.614（95% CI 1.292-5.288）。亚组分析表明，在中/低分化（均 P<.05）、T1-T4a、N0-N2b 或 I-IVa 期疾病的患者中，年龄的增加与较差的 OS 预后显著相关（均 P<.05）。
年轻患者倾向于表现出晚期 N 分类。诊断时年龄的增加与 OS 较差的风险显著相关。然而，在考虑受侵袭性疾病影响的患者时，年龄与下咽 SCC 死亡风险的增加无关。在高危患者中，在做出治疗决策时，应考虑肿瘤特征而不是年龄。
