Abstract
Identifying the causes of death in head and neck cancer patients can optimize follow‐up and therapeutic strategies, but studies in oropharyngeal squamous cell carcinoma (OPSCC) patients stratified by HPV status are lacking. We report cause‐specific mortality in a population‐based cohort of patients with OPSCC. Patients who had been diagnosed with OPSCC (n = 1541) between 2000 and 2014 in eastern Denmark were included in the study. Causes of death were collected through medical files and the Danish National Cause of Death registry. Deaths were grouped as (1) primary oropharyngeal cancer, (2) secondary malignancies, (3) cardiovascular and pulmonary disease, or (4) other/unspecified. The cumulative incidence of death and specific causes of death were determined using risk analysis. At follow‐up, 723 (47.5%) patients had died. The median time to and cause of death were determined: oropharyngeal cancer (n = 432; 1.00 year), secondary malignancies (n = 131; 2.37 years), cardiovascular and pulmonary causes (n = 58; 3.48 years), and unspecified causes (n = 102; 3.42 years). HPV/p16 status was the strongest predictor of improved survival across all causes of death. The only cause of death to decrease in incidence over the 2 years after treatment was death from OPSCC. HPV/p16 positivity was an independent factor for improved survival across all causes of death in patients with OPSCC. In addition, both HPV‐positive and HPV‐negative OPSCC patients faced high 5‐ and 10‐year mortality rates. Implementing secondary screening and prevention strategies for late toxicity and mortality are major goals in managing the treatment of these patients.
Highlights
In eastern Denmark, as in the rest of the Western world, the incidence of oropharyngeal squamous cell carcinomas (OPSCC) is increasing, mainly due to the increase in a subset of tumors associated with human papillomavirus (HPV) infection [1,2,3,4]
P16 positive is a strong predictor of favorable prognosis across all causes of death
Most patients who died from primary OPSCC died within the first 2 years of diagnosis, and only 9% (n = 38) of the patients died after 5 years
Summary
In eastern Denmark, as in the rest of the Western world, the incidence of oropharyngeal squamous cell carcinomas (OPSCC) is increasing, mainly due to the increase in a subset of tumors associated with human papillomavirus (HPV) infection [1,2,3,4]. This group of younger patients displays a better overall and progression-free survival as well as survival after progression compared with the group of cancers induced by smoking and alcohol Smoking and alcohol use are causative factors for developing OPSCC, and it is likely that competing diseases might be another cause of death in this group, for example, cardiovascular or pulmonary diseases.
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