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Category: Volume 08 Issue 02 February 2020
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Title: Comorbidities: Are they an Independent Predictor for Overall Survival in Oral Cavity Cancer?

Authors: Dr Radhikadevi B, Dr Mary Thomas, Dr Nebu Abraham George

 DOI: https://dx.doi.org/10.18535/jmscr/v8i2.41

Abstract

Background and Aims: This study was undertaken to identify the comorbidities which have an independent impact on overall survival (OS) and validate the use of Charlson’s comorbidity index (CCI) in patients with oral cavity cancer.

Methods: Data of 472 patients (age, sex, tumor site, Tumor (T) stage, Node(N) stage, comorbidities, and treatment) were collected from the case files and CCI score was calculated. Univariate analysis was done and significant variables were subjected to multiple cox regression analysis to identify the possible independent predictive factors of mortality. Cox proportional hazard model to estimate the hazard ratio for overall survival was used. The survival probability was estimated using Kaplan-Meier method and differences of survival were compared by log rank test.

Results: A univariate analysis done on the variables affecting mortality showed a p < 0.2 for tumor size, nodal spread, hypertension, diabetes, carcinomabuccal mucosa and lower alveolus, age >70 years and CCI score. Nodal spread, hypertension and diabetes mellitus and CCI score were identified as independent predictive factors for overall survival using multiple cox regression. CCI score was identified as an independent predictor of OS using Kaplan Meier analysis. Hypertension (35.2%) was the most common comorbidity in our study population.

Conclusion: Comorbidities have a significant impact on the overall survival of oral cavity cancer patients.CCI score is a valid tool to help the clinician assess the prognosis at initially and enable him to choose the optimal treatment which is less toxic to the patient and more cost effective.

Keywords: Regression Analysis, Comorbidity, Prognosis, Hypertension, Diabetes Mellitus, Head and Neck Neoplasms.

References

  1. Sarfati D, Tan L, Blakely T, et al. Comorbidity among patients with colon cancer in New Zealand. N Z Med J. 2011;124(1338):76–88.
  2. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
  3. Feinstein AR. Pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970; 23(7):455–68.
  4. Piccirillo JF, Lacy PD, Basu A, Spitznagel EL. Development of a new head and neck cancer-specific comorbidity index. Arch Otolaryngol Head Neck Surg. 2002;128:1172–79
  5. Paleri V, Wight RG, Silver CE. Comorbidity in head and neck cancer: a critical appraisal and recommendations for practice. Oral Oncol 2010; 46: 712–19.
  6. Asio J, Kamulegeya A. Banura C. Survival and associated factors among patients with oral squamous cell carcinoma (OSCC) in Mulago hospital, Kampala, Uganda. Cancers Head Neck. 2018 3:9.
  7. Göllnitz I, Inhestern J, Wendt TG et al. Role of comorbidity on outcome of head and neck cancer: a population based study in Thuringia, Germany. Cancer Med. 2016 5(11):3260-71.
  8. Kallogjeri D, Piccirillo JF, Spitznagel EL et al. Comparison of Scoring Methods for ACE- 27: Simpler Is Better. J Geriatr Oncol. 2012;3(3):238–45.
  9. Rose BS, Jeong JH, Nath SK, Lu SM, Mell LK. Population based study of competing mortality in head and neck cancer. J. Clin. Oncol. 2011;29:3503–09.
  10. Gronberg BH, Sundstrom S, Kaasa S, Bremnes RM, Flotten O, Amundsen T et al. Influence of comorbidity on survival, toxicity and health-related quality of life in patients with advanced non-small-cell lung cancer receiving platinum-doublet chemotherapy. Eur J Cancer. 2010;46 (12):2225–34.
  11. Hassett MJ, Rao SR, Brozovic S, Stahl JE, Schwartz JH, Maloney B et al. Chemotherapy related hospitalization among community cancer center patients. The 2011;16(3):378–87.
  12. Zauderer M, Patil S, Hurria A. Feasibility and toxicity of dose-dense adjuvant chemotherapy in older women with breast cancer. Breast cancer research and treatment. 2009;117(1):205–10. 
  13. Ranc K, Jorgensen ME, Friis S, Carstensen B. Mortality after cancer among patients with diabetes mellitus:effect of diabetes duration and treatment. Diabetologia.2014;5(5):927-34.
  14. De Oliveira LR. Ribeiro-Silva A, Zucoloto S. Incidence and survival profile of patients with oral squamous cell carcinoma in a Brazilian population. Journal Brasileiro de Patologia e Medicina Laboratorial. 2006;42, (5): 385–92.
  15. Honorato J, Camisasca DR, Silva LE, Dias FL, Faria PAS, Lourenço SQC. Overall survival analysis in oral squamous cell carcinoma patients diagnosed at the National  Cancer Institute. Revista Brasileira de Epidemiologia.2009;12:69–81.
  16. Boje CR, Dalton SO, Gronborg TK, et al. The impact of comorbidity on outcome in 12,623 Danish Head and Neck Cancer Patients: a population based study from the  DAHANCA database. Acta Oncol 2013;52: 285–93.
  17. Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL Jr. Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 2004;291(20):2441–7.
  18. Troeltzsch M, Probst FA, Rominger A. Comorbidity Assessment in Patients With Oral Squamous Cell Carcinoma: Can Imaging Techniques (Fludeoxyglucose Positron- Emission Tomographic Computed Tomography and Contrast-Enhanced Computed tomography) Provide Additional Information? J Oral MaxillofacSurg 2018;76:190-8.
  19. Ketch T, Biaggioni I, Robertson R, Robertson D. Four faces of baroreflex failure: hypertensive crisis, volatile hypertension, orthostatic tachycardia, and malignant vagotonia. Circulation 2002;105 (21):2518–23.
  20. Dyer AR, Stamler J, Berkson DM, Lindberg HA, Stevens E. High blood-pressure: a risk factor for cancer mortality? Lancet. 1975;1:1051-1056.
  21. Mouhayar E, Salahudeen A. Hypertension in Cancer Patients Tex Heart Inst J. 2011; 38(3):263–265.
  22. Misra S. Systemic hypertension and non-cardiac surgery. Indian J Anaesth. 2017;61(9):697.
  23. Lin K, Patel SG, Chu PY, Matsuo JM, Singh B, Wong RJ, Kraus DH, Shaha AR, Shah JP, Boyle JO. Second primary malignancy of the aerodigestive tract in patients treated for  cancer of the oral cavity and larynx. Head Neck. 2005;27(12):1042-8.
  24. Yang YH, Warnakulasuriya S. Effect of comorbidities on the management and prognosis in patients with oral cancer. Translational Research in Oral Oncology. 2016. XX: 1–8
  25. Piccirillo JF, Wells CK, Sasaki CT, Feinstein AR. New clinical severity staging system for cancer of the larynx. Five-year survival rates. Ann Otol Rhinol Laryngol 1994;103(2):83–92.
  26. Datema FR, Ferrier MB, Schroeffvan der MP, Baatenburg de Jong RJ. Impact of comorbidity on short-term mortality and overall survival of head and neck cancer patients. Head Neck 2010;32(6):728–36.

Corresponding Author

Dr Mary Thomas

Additional Professor Department of Anesthesiology, Regional Cancer Centre, Trivandrum, Kerala India