Abstract
The purpose of this study was to evaluate the value of routine blood markers regarding their predictive potential for treatment outcomes of elderly head-and-neck squamous cell carcinoma (HNSCC) patients. In total, 246 elderly HNSCC patients (≥65 years) undergoing (chemo)radiotherapy from 2010 to 2018 were analyzed for treatment outcomes, depending on their hemoglobin, glomerular filtration rate (GFR), C-reactive protein (CRP) and albumin values, representing anemia, kidney function, inflammation and nutrition status, respectively. Local/locoregional control, progression-free and overall survival (OS) were calculated using the Kaplan–Meier method. Cox analyses were performed to examine the influence of blood parameters on oncological outcomes. In the univariate Cox regression analysis, hemoglobin ≤ 12 g/dL (HR = 1.536, p < 0.05), a GFR ≤ 60 mL/min/1.73 m2 (HR = 1.537, p < 0.05), a CRP concentration > 5 mg/L (HR = 1.991, p < 0.001) and albumin levels ≤ 4.2 g/dL (HR = 2.916, p < 0.001) were significant risk factors for OS. In the multivariate analysis including clinical risk factors, only performance status (HR = 2.460, p < 0.05) and baseline albumin (HR = 2.305, p < 0.05) remained significant prognosticators. Additionally, baseline anemia correlated with the prevalence of higher-grade chronic toxicities. We could show for the first time that laboratory parameters for anemia (and at least partly, tumor oxygenation), decreased renal function, inflammation and reduced nutrition status are associated with impaired survival in elderly HNSCC patients undergoing (chemo)radiotherapy.
Highlights
IntroductionThe prevalence of HPV-related head-and-neck squamous cell carcinoma (HNSCC), which typically affects younger patients, is increasing, the average age of HNSCC patients at the time of diagnosis ranges between 60 and 70, and one in four HNSCC patients are older than 70 years [2,3]
With more than 650,000 new diagnoses and 300,000 deaths per year, head-and-neck squamous cell carcinoma (HNSCC) constitutes a very common malignancy with both high morbidity and mortality [1]. the prevalence of HPV-related HNSCC, which typically affects younger patients, is increasing, the average age of HNSCC patients at the time of diagnosis ranges between 60 and 70, and one in four HNSCC patients are older than 70 years [2,3]
We examined the role of these surrogate laboratory parameters regarding oncological outcomes and treatment-related toxicities in a large single-center study consisting of 246 geriatric HNSCC patients receiving radiotherapy or chemoradiation
Summary
The prevalence of HPV-related HNSCC, which typically affects younger patients, is increasing, the average age of HNSCC patients at the time of diagnosis ranges between 60 and 70, and one in four HNSCC patients are older than 70 years [2,3]. The prevalence of elderly cancer patients will increase dramatically over the decades [4]. The clinical profile of elderly HNSCC patients is different to younger HNSCCs patients, and elderly HNSCC cohorts comprise a higher percentage of female patients and a lower presence of alcohol or tobacco abuse [9]. Altered fractionation regimens such as hyperfractionation have shown less benefit in comparison with younger HNSCC patients [13]. There is a strong need for identifying elderly patients that may not benefit from these standard therapies and may require treatment adaption
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