Predictors of Survival in Veterans with Head and Neck Cancer Treated Surgically.

Abstract

Background: Squamous cell carcinoma (SCC) accounts for 90% of all head and neck cancers. In veterans, the prevalence of head and neck SCC is nearly twice as high compared with the civilian population. Neck dissection plays an important role in the treatment algorithm for patients with head and neck SCC. The aim of this manuscript was to investigate predictors of survival in patients with head and neck SCC who underwent curative treatment. Methods: Patients with head and neck SCC who underwent treatment with curative intent were included in this study. Data collected included clinical-demographic characteristics, tumor characteristics, and outcome. The primary endpoint was 3-year overall survival (OS), and the secondary endpoints were disease recurrence and distant metastases. Results: A total of 149 patients met inclusion criteria, and most patients were treated with surgery plus adjuvant chemoradiation (52%). The 3-year OS for the entire cohort was 55.7%. There was no statistically significant difference in mortality when comparing the various treatment types. Black patients (hazard ratio [HR] = 1.70, P = .023) and other non-white patients (HR = 3.88, P = .027) had worse 3-year OS compared with white patients. Advanced tumor classification (T4a) was also associated with worse 3-year OS (HR = 3.088, P = .003) and increased risk of cancer recurrence or distant metastases (HR = 3.34, P = .013). Conclusions: Risk factors linked to poor survival among this cohort of veterans with head and neck SCC included non-white race and advanced tumor classification. Neck dissection remains an integral aspect of the treatment algorithm for SCC of the head and neck and can provide regional control of malignant disease.