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.
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.
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.
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)
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.