21 Citations (Scopus)

Abstract

Purpose: For locoregionally recurrent head and neck squamous cell carcinoma (HNSCC), appropriate therapeutic decisions remain unclear. We examined the treatment outcomes of a national cohort to determine suitable treatments for and prognostic factors in patients with locoregionally recurrent HNSCCs at different stages and sites. Patients and methods: We analyzed data of > 20-year-old patients with HNSCC at American Joint Committee on Cancer clinical stages I-IV without metastasis from Taiwan National Health Insurance and cancer registry databases. The index date was the date of recurrent HNSCC diagnosis. Recurrent HNSCC was defined as the annotation of locoregional recurrence with tissue proof in cancer registry databases. The enrolled patients were categorized into three groups: Group 1 comprised those undergoing chemotherapy (CT) alone; Group 2 comprised those receiving reirradiation (re-RT) alone (total radiation dose ≥ 60 Gy through intensity modulation radiation therapy [IMRT]); Group 3 comprised those receiving concurrent chemoradiotherapy (CCRT) alone (irradiation total dose ≥60 Gy through IMRT); and Group 4 comprised those receiving salvage surgery with or without RT or CT. Results: We enrolled 4,839 and 28,664 HNSCC patients with and without locoregional recurrence, respectively (median follow-up, 3.25 years). Locoregional recurrence rate and incidence were 14.44% and 40.73 per 1,000 person-years, respectively. Age ≥ 65 years, Charlson comorbidity index (CCI) score > 6, advanced clinical stage at first diagnosis, and recurrence-free interval < 1 year were significant independent prognostic risk factors for overall survival as per univariate and multivariate Cox regression analyses. After adjusting for age, sex, CCI scores, clinical stage at first diagnosis, and recurrence-free interval, adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for overall mortality in recurrent clinical stages I and II were 0.63 (0.45-0.89, p = 0.009), 0.65 (0.52-0.83, p < 0.001), and 0.32 (0.26-0.40, p < 0.001) in Groups 2, 3, and 4, respectively, whereas they were 1.23 (0.99-1.52, p = 0.062), 0.69 (0.60-0.79, p < 0.001), and 0.39 (0.34-0.44, p < 0.001) for Groups 2, 3, and 4, respectively, for overall mortality in recurrent clinical stage III and IV. Conclusions: Age, CCI score, clinical stage at first diagnosis, and recurrencefree interval are significant independent prognostic factors for overall survival of recurrent HNSCC patients. Regardless of recurrence stage or site, salvage surgery is the recommended first recurrent HNSCC treatment choice. Re-RT alone and CCRT are more suitable for inoperable recurrent early-stage oral and nonoral cavity recurrent HNSCCs, respectively.

Original languageEnglish
Pages (from-to)55600-55612
Number of pages13
JournalOncotarget
Volume8
Issue number33
DOIs
Publication statusPublished - 2017

Fingerprint

Survival
Incidence
Recurrence
Comorbidity
Chemoradiotherapy
Registries
Radiotherapy
Databases
Drug Therapy
Neoplasms
Mortality
National Health Programs
Carcinoma, squamous cell of head and neck
Taiwan
Mouth
Therapeutics
Regression Analysis
Confidence Intervals
Radiation
Neoplasm Metastasis

Keywords

  • Head and neck cancer
  • Incidence
  • Prognostic factors
  • Recurrence
  • Survival

ASJC Scopus subject areas

  • Oncology

Cite this

@article{8db044118bae4accba74514503d41d10,
title = "Locoregionally recurrent head and neck squamous cell carcinoma: Incidence, survival, prognostic factors, and treatment outcomes",
abstract = "Purpose: For locoregionally recurrent head and neck squamous cell carcinoma (HNSCC), appropriate therapeutic decisions remain unclear. We examined the treatment outcomes of a national cohort to determine suitable treatments for and prognostic factors in patients with locoregionally recurrent HNSCCs at different stages and sites. Patients and methods: We analyzed data of > 20-year-old patients with HNSCC at American Joint Committee on Cancer clinical stages I-IV without metastasis from Taiwan National Health Insurance and cancer registry databases. The index date was the date of recurrent HNSCC diagnosis. Recurrent HNSCC was defined as the annotation of locoregional recurrence with tissue proof in cancer registry databases. The enrolled patients were categorized into three groups: Group 1 comprised those undergoing chemotherapy (CT) alone; Group 2 comprised those receiving reirradiation (re-RT) alone (total radiation dose ≥ 60 Gy through intensity modulation radiation therapy [IMRT]); Group 3 comprised those receiving concurrent chemoradiotherapy (CCRT) alone (irradiation total dose ≥60 Gy through IMRT); and Group 4 comprised those receiving salvage surgery with or without RT or CT. Results: We enrolled 4,839 and 28,664 HNSCC patients with and without locoregional recurrence, respectively (median follow-up, 3.25 years). Locoregional recurrence rate and incidence were 14.44{\%} and 40.73 per 1,000 person-years, respectively. Age ≥ 65 years, Charlson comorbidity index (CCI) score > 6, advanced clinical stage at first diagnosis, and recurrence-free interval < 1 year were significant independent prognostic risk factors for overall survival as per univariate and multivariate Cox regression analyses. After adjusting for age, sex, CCI scores, clinical stage at first diagnosis, and recurrence-free interval, adjusted hazard ratios (aHRs; 95{\%} confidence intervals [CIs]) for overall mortality in recurrent clinical stages I and II were 0.63 (0.45-0.89, p = 0.009), 0.65 (0.52-0.83, p < 0.001), and 0.32 (0.26-0.40, p < 0.001) in Groups 2, 3, and 4, respectively, whereas they were 1.23 (0.99-1.52, p = 0.062), 0.69 (0.60-0.79, p < 0.001), and 0.39 (0.34-0.44, p < 0.001) for Groups 2, 3, and 4, respectively, for overall mortality in recurrent clinical stage III and IV. Conclusions: Age, CCI score, clinical stage at first diagnosis, and recurrencefree interval are significant independent prognostic factors for overall survival of recurrent HNSCC patients. Regardless of recurrence stage or site, salvage surgery is the recommended first recurrent HNSCC treatment choice. Re-RT alone and CCRT are more suitable for inoperable recurrent early-stage oral and nonoral cavity recurrent HNSCCs, respectively.",
keywords = "Head and neck cancer, Incidence, Prognostic factors, Recurrence, Survival",
author = "Chang, {Jer Hwa} and Wu, {Chia Che} and Yuan, {Kevin Sheng Po} and Wu, {Alexander T.H.} and Wu, {Szu Yuan}",
year = "2017",
doi = "10.18632/oncotarget.16340",
language = "English",
volume = "8",
pages = "55600--55612",
journal = "Oncotarget",
issn = "1949-2553",
publisher = "Impact Journals LLC",
number = "33",

}

TY - JOUR

T1 - Locoregionally recurrent head and neck squamous cell carcinoma

T2 - Incidence, survival, prognostic factors, and treatment outcomes

AU - Chang, Jer Hwa

AU - Wu, Chia Che

AU - Yuan, Kevin Sheng Po

AU - Wu, Alexander T.H.

AU - Wu, Szu Yuan

PY - 2017

Y1 - 2017

N2 - Purpose: For locoregionally recurrent head and neck squamous cell carcinoma (HNSCC), appropriate therapeutic decisions remain unclear. We examined the treatment outcomes of a national cohort to determine suitable treatments for and prognostic factors in patients with locoregionally recurrent HNSCCs at different stages and sites. Patients and methods: We analyzed data of > 20-year-old patients with HNSCC at American Joint Committee on Cancer clinical stages I-IV without metastasis from Taiwan National Health Insurance and cancer registry databases. The index date was the date of recurrent HNSCC diagnosis. Recurrent HNSCC was defined as the annotation of locoregional recurrence with tissue proof in cancer registry databases. The enrolled patients were categorized into three groups: Group 1 comprised those undergoing chemotherapy (CT) alone; Group 2 comprised those receiving reirradiation (re-RT) alone (total radiation dose ≥ 60 Gy through intensity modulation radiation therapy [IMRT]); Group 3 comprised those receiving concurrent chemoradiotherapy (CCRT) alone (irradiation total dose ≥60 Gy through IMRT); and Group 4 comprised those receiving salvage surgery with or without RT or CT. Results: We enrolled 4,839 and 28,664 HNSCC patients with and without locoregional recurrence, respectively (median follow-up, 3.25 years). Locoregional recurrence rate and incidence were 14.44% and 40.73 per 1,000 person-years, respectively. Age ≥ 65 years, Charlson comorbidity index (CCI) score > 6, advanced clinical stage at first diagnosis, and recurrence-free interval < 1 year were significant independent prognostic risk factors for overall survival as per univariate and multivariate Cox regression analyses. After adjusting for age, sex, CCI scores, clinical stage at first diagnosis, and recurrence-free interval, adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for overall mortality in recurrent clinical stages I and II were 0.63 (0.45-0.89, p = 0.009), 0.65 (0.52-0.83, p < 0.001), and 0.32 (0.26-0.40, p < 0.001) in Groups 2, 3, and 4, respectively, whereas they were 1.23 (0.99-1.52, p = 0.062), 0.69 (0.60-0.79, p < 0.001), and 0.39 (0.34-0.44, p < 0.001) for Groups 2, 3, and 4, respectively, for overall mortality in recurrent clinical stage III and IV. Conclusions: Age, CCI score, clinical stage at first diagnosis, and recurrencefree interval are significant independent prognostic factors for overall survival of recurrent HNSCC patients. Regardless of recurrence stage or site, salvage surgery is the recommended first recurrent HNSCC treatment choice. Re-RT alone and CCRT are more suitable for inoperable recurrent early-stage oral and nonoral cavity recurrent HNSCCs, respectively.

AB - Purpose: For locoregionally recurrent head and neck squamous cell carcinoma (HNSCC), appropriate therapeutic decisions remain unclear. We examined the treatment outcomes of a national cohort to determine suitable treatments for and prognostic factors in patients with locoregionally recurrent HNSCCs at different stages and sites. Patients and methods: We analyzed data of > 20-year-old patients with HNSCC at American Joint Committee on Cancer clinical stages I-IV without metastasis from Taiwan National Health Insurance and cancer registry databases. The index date was the date of recurrent HNSCC diagnosis. Recurrent HNSCC was defined as the annotation of locoregional recurrence with tissue proof in cancer registry databases. The enrolled patients were categorized into three groups: Group 1 comprised those undergoing chemotherapy (CT) alone; Group 2 comprised those receiving reirradiation (re-RT) alone (total radiation dose ≥ 60 Gy through intensity modulation radiation therapy [IMRT]); Group 3 comprised those receiving concurrent chemoradiotherapy (CCRT) alone (irradiation total dose ≥60 Gy through IMRT); and Group 4 comprised those receiving salvage surgery with or without RT or CT. Results: We enrolled 4,839 and 28,664 HNSCC patients with and without locoregional recurrence, respectively (median follow-up, 3.25 years). Locoregional recurrence rate and incidence were 14.44% and 40.73 per 1,000 person-years, respectively. Age ≥ 65 years, Charlson comorbidity index (CCI) score > 6, advanced clinical stage at first diagnosis, and recurrence-free interval < 1 year were significant independent prognostic risk factors for overall survival as per univariate and multivariate Cox regression analyses. After adjusting for age, sex, CCI scores, clinical stage at first diagnosis, and recurrence-free interval, adjusted hazard ratios (aHRs; 95% confidence intervals [CIs]) for overall mortality in recurrent clinical stages I and II were 0.63 (0.45-0.89, p = 0.009), 0.65 (0.52-0.83, p < 0.001), and 0.32 (0.26-0.40, p < 0.001) in Groups 2, 3, and 4, respectively, whereas they were 1.23 (0.99-1.52, p = 0.062), 0.69 (0.60-0.79, p < 0.001), and 0.39 (0.34-0.44, p < 0.001) for Groups 2, 3, and 4, respectively, for overall mortality in recurrent clinical stage III and IV. Conclusions: Age, CCI score, clinical stage at first diagnosis, and recurrencefree interval are significant independent prognostic factors for overall survival of recurrent HNSCC patients. Regardless of recurrence stage or site, salvage surgery is the recommended first recurrent HNSCC treatment choice. Re-RT alone and CCRT are more suitable for inoperable recurrent early-stage oral and nonoral cavity recurrent HNSCCs, respectively.

KW - Head and neck cancer

KW - Incidence

KW - Prognostic factors

KW - Recurrence

KW - Survival

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DO - 10.18632/oncotarget.16340

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JF - Oncotarget

SN - 1949-2553

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