Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea.
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2022 Jan;37(1):190-200. doi: 10.3904/kjim.2020.636. Epub 2021 Dec 21.
BACKGROUND/AIMS: Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients.
Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III-IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients.
Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability.
Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.
背景/目的：局部晚期头颈部鳞状细胞癌（LA-HNSCC）的治疗决策较为复杂，通常需要采用多模态治疗。然而，老年患者完成治疗具有挑战性。因此，我们研究了老年 LA-HNSCC 患者的疾病特征、真实世界的治疗方法和结局。
从 2005 年 1 月至 2015 年 12 月包含 445 例 III-IVB 期 LA-HNSCC 患者的大型全国性队列中选择老年患者（年龄≥70 岁）。回顾性分析并比较了老年患者和年轻患者的数据。
老年患者占所有患者的 18.7%（83/445），中位年龄为 73 岁（范围，70-89 岁）。与年轻患者相比，老年患者原发肿瘤位于下咽和喉部的比例更高，T 分期更晚，功能状态更差。对于老年患者的治疗策略，44.5%的患者接受同步放化疗（CCRT），41.0%的患者接受手术，14.5%的患者未完成计划治疗。27.7%（23/83）的老年患者接受了诱导化疗（IC）；IC 的首选方案是氟尿嘧啶和顺铂（47.9%）。对于 CCRT，每周顺铂的处方频率比 3 周顺铂高 3.3 倍（62.2%比 18.9%）。老年患者的死亡风险比年轻患者高 60%（风险比，1.6；p=0.035）。口腔癌患者的生存概率最差。
老年 LA-HNSCC 患者具有侵袭性肿瘤特征，接受的治疗强度较低，生存状况较差。需要进一步针对老年人群进行研究。
