Young age is not a predictor of disease specific survival in oral cancer: A multi-institutional study.

Affiliation

Oh LJ(1), Satgunaseelan L(2), Asher R(3), Veness M(4), Smee R(5), Goldstein D(6), Gopalakrishna Iyer N(7), Balasubramanian D(8), Low H(1), Palme CE(1), Gupta R(9), Clark JR(10).
Author information:
(1)Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, NSW, Australia.
(2)Department of Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
(3)Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia.
(4)Department of Radiation Oncology, Crown Mary Westmead Cancer Centre, Westmead Hospital, Westmead, NSW, Australia.
(5)Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW, Australia.
(6)Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Canada.
(7)Department of Head & Neck Surgery, Division of Surgery & Surgical Oncology, Duke-NUS Centre, Singapore.
(8)Centre for Head and Neck Surgery and Oncology, Surgical Oncology, Amrita Hospital, Fridabad, India.
(9)Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, New South Wales Health Pathology, Royal Prince Alfred Hospital, Camperdown, Sydney, Australia.
(10)Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, NSW, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, NSW, Australia. Electronic address: [Email]

Abstract

BACKGROUND: Over the last few decades evidence has accumulated for increasing incidence of oral cavity squamous cell carcinoma (OSCC) in a younger cohort. Prior studies examining the effect of age at diagnosis on prognosis have produced conflicting data. METHODS: A multi-institutional cohort study was performed across 6 different sites in Australia, Canada, India and Singapore. Disease-free (DFS), overall (OS) and disease-specific (DSS) survival were analysed. The association of the number of adverse features with survival outcomes was investigated. RESULTS: From 3179 patients, age was a significant predictor of OS with patients older than 45 years having a 66% increased risk of death (HR 1.66, 95%CI 1.33 - 2.07, p < 0.001). The number of adverse features was a significant predictor of OS with 3 or more adverse features having a 199% increased risk (HR 2.99, 95%CI 2.61-3.43. p < 0.001). The estimate effect was greater in patients ≤ 45 years (HR 3.49 vs HR 2.81). Age was not a significant predictor of DSS with similar rates of death from OSCC in multivariable models. The number of adverse features was a significant predictor of DFS with ≥ 3 adverse features having a 140% increased risk of death. The number of adverse features was a significant predictor of DSS with ≥ 3 adverse features having a 230% increased risk of disease specific death. CONCLUSIONS: Age is not an independent predictor of disease specific mortality in OSCC. Differences in outcomes are due to the confounding effect of adverse clinicopathological features and the ability to tolerate surgery and adjuvant therapy.