The impact of advanced age on outcomes in squamous cell carcinoma of the head and neck.

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5577 Background: Limited data are available regarding outcomes in elderly head and neck cancer patients. This retrospective study was designed to characterize head and neck cancer in geriatric patients in the UNC Tumor Registry. Methods: Of 1,598 patients identified from the registry, 1,291 patients were <70 years old (young group, YG) and 307 patients were > 70 (elderly group, EG) at diagnosis. Both overall survival (OS), calculated from diagnosis to death or the last follow up, and relapse free survival (RFS) were censored at 60 months. Log-rank test was used to compare survival difference. Cox proportional hazard model was used to estimate hazard ratio, adjusting for potential confounding factors. All tests were performed in R 2.13.1. Results: EG patients were more likely to present at an early stage with 25% presenting at stage I and 37% presenting at stage IV compared to 17% and 51% respectively in YG. EG had a median OS of 35 months (95% CI: 28-41 months) compared to approximately 60 months in YG (p < 0.0001 log rank test). The median RFS for EG and YG are 25 (95% CI: 20-32 months) and 44 (95% CI: 38-52 months) months respectively (p < 0.0001 log rank test). When controlling for possible confounders, EG patients were nearly twice as likely to die (HR 1.94, 95% CI 1.635-2.302, p<0.0001) and 70% more likely to relapse in 5 years compared to YG (HR 1.704, 95% CI 1.449-2.004, p<0.05). The median life expectancy for elderly patients in our study was nearly 5 years for stage I/II and <2 years for stage III/IV. Conclusions: Poor OS and RFS in elderly patients compared to younger patients in this study indicate a need for further investigation considering comorbidities and aggressiveness of treatment. Significant differences in life expectancy in elderly patients with early versus late disease may help guide patients and clinicians in determining how aggressively to treat.