Survival of patients with head and neck (H&N) cancers: a nationwide study from France in 2008-2012 (EPICORL study)

Date

09 Oct 2016

Session

Poster display

Presenters

Florence Huguet

Citation

Annals of Oncology (2016) 27 (6): 328-350. 10.1093/annonc/mdw376

Authors

F. Huguet1, S. Témam2, Y. Pointreau3, S.P. Thiébaut4, M. Bec5, L. Lévy-Bachelot5, C. Even6, L. Geoffrois7, M. Schwarzinger4

Author affiliations

  • 1 Department Of Radiation Oncology, Tenon Hospital, 75020 - Paris/FR
  • 2 Surgical Oncology, Institut Gustave Roussy, 94800 - Villejuif/FR
  • 3 Oncology, Centre Jean Bernard, Le Mans/FR
  • 4 Epidemiology, THEN (Translational Health Economics Network), Paris/FR
  • 5 Market Access, MSD, Courbevoie/FR
  • 6 Medical Oncology, Institut Gustave Roussy, Villejuif/FR
  • 7 Medical Oncology, Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre les Nancy/FR
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Resources

Background

Tobacco smoking and heavy alcohol use are the main risk factors of H&N cancer. The same risk factors entail severe comorbidities that may worsen prognosis in patients diagnosed with H&N cancer.

Methods

We completed a retrospective cohort study using the French National Hospital Discharge (PMSI) database. We identified all adult patients residing in Metropolitan France and diagnosed with H&N cancer (ICD-10: C00-C06; C09-C14; C30.0; C31; C32) in 2008-2012. Cancer location and stage (early I/II; advanced III/IVb; distant metastatic IVc) were determined at diagnosis. Time to relapse, secondary primary H&N cancer, other primary cancers, Charlson comorbidities were recorded until last hospital stay in 2013. Hazard ratios (HR) for in-hospital death were estimated in a multivariate Cox model with use of time-dependent variables.

Results

131,965 French adults were identified with H&N cancer in 2008-2012: 79.4% were male with median (IQR) age of 61 (54-71) at diagnosis. Overall survival at 5 years was 34.0% (95% CI, 33.5%-34.4%) over a follow-up of 196,000 person-years. As compared to 23.2% patients with laryngeal cancer, survival was significantly lower for 29.3% patients with oral cavity cancer (HR = 1.25), 19.5% patients with oropharynx cancer (HR = 1.22), or 12.8% patients with hypopharynx cancer (HR = 1.26). As compared to 30.7% patients with early cancer at diagnosis, survival was significantly lower for 12.1% patients with distant metastasis (HR = 3.02) and 57.2% patients with advanced cancer (HR = 1.76). The relapse rate was 22.8% in patients with early cancer and 37.9% in patients with advanced cancer, with significantly lower survival (HR = 6.77). Secondary primary H&N cancers were detected in 6.1% patients at diagnosis (HR = 1.15) and 2.3% patients in the follow-up (HR = 1.79). About 31% patients had another primary cancer cared in the study period (including 10.1% lung: HR = 1. 71). About 52% patients had other severe comorbidities incurring significantly lower survival.

Conclusions

This is the first national study on the survival of patients with H&N cancer in France. Relapse had the strongest impact on prognosis. In addition, about two-third patients had another primary cancer or severe comorbidities worsening prognosis.

Clinical trial identification

Legal entity responsible for the study

THEN (Translational Health Economics Network)

Funding

MSD France

Disclosure

F. Huguet, S. Témam, Y. Pointreau, S.P. Thiébaut, C. Even, L. Geoffrois, M. Schwarzinger: Corporate-sponsored research. M. Bec, L. Lévy-Bachelot: MSD employee.

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