Ansarin Mohssen, De Berardinis Rita, Corso Federica, Giugliano Gioacchino, Bruschini Roberto, De Benedetto Luigi, Zorzi Stefano, Maffini Fausto, Sovardi Fabio, Pigni Carolina, Scaglione Donatella, Alterio Daniela, Cossu Rocca Maria, Chiocca Susanna, Gandini Sara, Tagliabue Marta
Division of Otolaryngology and Head and Neck Surgery, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Department of Experimental Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
Front Oncol. 2021 Apr 12;11:616653. doi: 10.3389/fonc.2021.616653. eCollection 2021.
The prognostic role of age among patients affected by Oral Tongue Squamous Cell Carcinoma (OTSCC) is a topic of debate. Recent cohort studies have found that patients diagnosed at 40 years of age or younger have a better prognosis. The aim of this cohort study was to clarify whether age is an independent prognostic factor and discuss heterogeneity of outcomes by stage and treatments in different age groups.
We performed a study on 577 consecutive patients affected by primary tongue cancer and treated with surgery and adjuvant therapy according to stage, at European Institute of Oncology, IRCCS. Patients with age at diagnosis below 40 years totaled 109 (19%). Overall survival (OS), disease-free survival (DFS), tongue specific free survival (TSFS) and cause-specific survival (CSS) were compared by age groups. Multivariate Cox proportional hazards models were used to assess the independent role of age.
The median follow-up time was 5.01 years (range 0-18.68) years with follow-up recorded up to February 2020. After adjustment for all the significant confounding and prognostic factors, age remained independently associated with OS and DSF (respectively, p = 0.002 and p = 0.02). In CSS and TSFS curves, the role of age seems less evident (respectively, p = 0.14 and p = 0.0.37). In the advanced stage sub-group (stages III-IV), age was significantly associated with OS and CSS with almost double increased risk of dying (OS) and dying from tongue cancer (CSS) in elderly compared to younger groups (OS: HR = 2.16 95%, CI: 1.33-3.51, p= 0.001; CSS: HR = 1.76 95%, CI: 1.03-3.01, p = 0.02, respectively). In our study, young patients were more likely to be treated with intensified therapies (glossectomies types III-V and adjuvant radio-chemotherapy). Age was found as a prognostic factor, independently of other significant factors and treatment. Also the T-N tract involved by disease and neutrophil-to-lymphocyte ratio ≥3 were independent prognostic factors.
Young age at diagnosis is associated with a better overall survival. Fewer younger people than older people died from tongue cancer in advanced stages.
口腔舌鳞状细胞癌（OTSCC）患者中年龄的预后作用是一个有争议的话题。最近的队列研究发现，40岁及以下诊断出的患者预后较好。本队列研究的目的是阐明年龄是否为独立的预后因素，并讨论不同年龄组按分期和治疗的结局异质性。
我们对欧洲肿瘤研究所（IRCCS）的577例原发性舌癌患者进行了一项研究，这些患者根据分期接受了手术和辅助治疗。诊断时年龄低于40岁的患者共有109例（19%）。按年龄组比较总生存期（OS）、无病生存期（DFS）、舌特异性无病生存期（TSFS）和病因特异性生存期（CSS）。使用多变量Cox比例风险模型评估年龄的独立作用。
中位随访时间为5.01年（范围0 - 18.68年），随访记录截至2020年2月。在对所有显著的混杂和预后因素进行调整后，年龄仍与OS和DSF独立相关（分别为p = 0.002和p = 0.02）。在CSS和TSFS曲线中，年龄的作用似乎不太明显（分别为p = 0.14和p = 0.37）。在晚期亚组（III - IV期）中，年龄与OS和CSS显著相关，与年轻组相比，老年患者死亡（OS）和死于舌癌（CSS）的风险几乎增加一倍（OS：HR = 2.16，95%CI：1.33 - 3.51，p = 0.001；CSS：HR = 1.76，95%CI：1.03 - 3.01，p = 0.02）。在我们的研究中，年轻患者更有可能接受强化治疗（III - V型舌切除术和辅助放化疗）。年龄被发现是一个预后因素，独立于其他显著因素和治疗。疾病累及的T - N区域和中性粒细胞与淋巴细胞比值≥3也是独立的预后因素。
诊断时年龄较小与较好的总生存期相关。晚期死于舌癌的年轻人比老年人少。
