Cumulative odds of increased comorbid score in head and neck cancer.

Abstract

e17555 Background: Survival of head and neck cancer is impacted by known clinical factors, including anatomic subsite, stage of presentation, and treatment modality. An important clinical factor less explored is comorbidity burden. While it is known that a greater comorbidity burden is prognostic for poorer outcomes, it is unclear how the odds of presenting with increased comorbidity score is associated with head and neck cancer anatomic subsite. This study aimed at estimating the cumulative odds of increased comorbidity in head and neck cancer based on anatomic subsites. Methods: Data queried from National Cancer Database (2004-2015). Study sample (N = 328,504) consisted of Stage I-IV, Head and neck Squamous Cell Carcinoma (HNSCC) patients, with no missing demographic variables (age, sex, race, insurance status, local income, local population density). Multivariable cumulative logit model was used to estimate outcome of interest: odds of higher Charlson-Deyo comorbid condition score(CDCC) at HNSCC diagnosis. Results: Compared to patients diagnosed with oropharyngeal cancer (mostly HPV-related HNSCC), patients diagnosed with more tobacco-related HNSCC, such as laryngeal cancer (aOR: 1.69, 95% CI: 1.65-1.73), hypopharyngeal cancer (aOR: 1.33, 95% CI: 1.28-1.38), oral cavity (aOR: 1.26, 95% CI: 1.23-1.29), and sinonasal cancer (aOR: 1.12, 95% CI: 1.06-1.19) had greater odds of presenting with a higher CDCC. Patients with nasopharyngeal cancer did not statistically differ from oropharyngeal patients in odds of higher CDCC presentation. Conclusions: Patients diagnosed with cancers of larynx, hypopharynx and oral cavity (typically associated with tobacco and alcohol use) present with greater comorbid burden compared to patients diagnosed with oropharyngeal cancer (typically associated with HPV). It is important that the role of comorbidity burden be recognized in head and neck cancer prognostication.