Influence of Tumor Site on Survival in Young Patients with Head and Neck Squamous Cell Carcinoma.

Claudius Steffen,Max Heiland,Annekatrin Coordes,Carmen Stromberger,Christian Doll,Benedicta Beck-Broichsitter,Iris Piwonski,Grzegorz Kofla

doi:10.3390/curroncol29020082

Abstract

The number of patients under the age of 45 diagnosed with head and neck squamous cell carcinomas (HNSCC) is increasing, probably due to the incidence of oropharyngeal cancers. Comparisons of HNSCC in young and old patients regarding tumor site and survival in sample sizes of relevance are rarely published. The aim of the study was to analyze the differences in survival between age groups dependent on tumor site and the influence of oropharyngeal cancers on the rising rates of HNSCC in the young. The records of 4466 patients diagnosed with HNSCC were reviewed retrospectively. Patients younger than 45 years were divided further into four subgroups for specific age differences in the young. The influences of patient and clinicopathological characteristics on survival were assessed using Kaplan–Meier analyses. Among the patient cohort, 4.8% were younger than 45 years. Overall survival (OS) in these patients was better, with a 5-year OS of 66.1% (vs. 46.4%), while relapse-free survival (RFS) was better in the older patient population, with a 5-year RFS of 74.9% (vs. 68.1%). Decreased RFS in the young was found for advanced tumor stages and tumor sited at the larynx. Hypopharynx and advanced stages were independent risk factors for OS under 45 years. Overall, 44.4% of all HNSCC in patients under 30 years were nasopharyngeal cancers, and incidence decreased with age. The incidence of oropharyngeal cancers increased significantly with age. Better OS in the young may be explained by lower tumor and disease stages, whereas oropharyngeal tumors and HPV were not found to cause rising rates of HNSCC. Laryngeal malignancies in young patients might be related to an increased malignant potential and should, consequently, be treated as such.

Highlights

The association of head and neck squamous cell carcinomas (HNSCCs) with extrinsic risk factors such as smoking and alcohol is well known [1]
Our objectives were to (1) analyze survival rates and tumor distributions in patients aged under 45 years compared with older patients without bias produced by multiple institutions or time periods; (2) evaluate possible differences in frequencies of tumor sites, as well as clinicopathological factors, between young patients and older patients; and (3) examine the influence of these differences on survival with increasing ages using a more detailed aged-categorized analysis of the young patient group itself
4466 patients diagnosed with HNSCC with a median age at diagnosis of 63.0 years and a median follow-up time of 22.0 (0–100) months, were included

Summary

Introduction

The association of head and neck squamous cell carcinomas (HNSCCs) with extrinsic risk factors such as smoking and alcohol is well known [1]. About 50–70% of all HNSCC patients consume alcohol or tobacco [1], resulting in a mean age at diagnosis of around. In the age group of patients younger than 40 years, long-term exposure to these risk factors is very rare, and the proportion of HNSCCs in this group compared to the overall incidence of HNSCC is at a low level of around 2.7% [3] to 6% [4]. Several studies indicate a dependency on the site of tumors in these cases. One study could demonstrate increasing rates exclusively in SCCs of the tongue and tonsils [6]

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Conclusion