PURPOSE: Patients with head and neck cancer (HNC) are at high risk of death resulting from noncancer causes and second malignancies (ie, competing mortality). Variation in competing mortality risk complicates individual treatment choices and design and interpretation of clinical studies. METHODS: Using the Surveillance, Epidemiology, and End Results registry, we identified 34,568 patients with nonmetastatic squamous cell carcinoma of the head and neck diagnosed between 1994 and 2003. We developed a multivariable competing-risk regression model to stratify patients according to competing mortality risk and evaluate the impact of this risk on power loss in clinical studies. RESULTS: The 5-year cumulative incidences of all-cause mortality, HNC-specific mortality, and competing mortality were 51.3% (95% CI, 50.8% to 51.9%), 23.8% (95% CI, 23.3% to 24.2%), and 27.6% (95% CI, 26.8% to 28.3%), respectively. Factors associated with increased competing mortality were increasing age, male sex, black race, unmarried status, localized disease, higher socioeconomic status, nonsurgical treatment, and hypopharyngeal, nasopharyngeal, and oral cavity subsites. The 5-year cumulative incidences of competing mortality for patients in low-, medium-, and high-risk score tertiles were 20.0% (95% CI, 18.8% to 21.3%), 27.7% (95% CI, 26.3% to 29.1%), and 33.7% (95% CI, 32.2% to 35.2%), respectively. Compared with patients with low competing mortality risk, relative sample sizes required to show benefit of a treatment regarding all-cause mortality were 12% and 42% higher in the medium- and high-risk groups, respectively. CONCLUSION: Multiple factors affect risk of competing mortality among patients with HNC. Risk stratification would be useful to identify patients most likely to benefit from treatment intensification.
PURPOSE:Patients with head and neck cancer (HNC) are at high risk of death resulting from noncancer causes and second malignancies (ie, competing mortality). Variation in competing mortality risk complicates individual treatment choices and design and interpretation of clinical studies. METHODS: Using the Surveillance, Epidemiology, and End Results registry, we identified 34,568 patients with nonmetastatic squamous cell carcinoma of the head and neck diagnosed between 1994 and 2003. We developed a multivariable competing-risk regression model to stratify patients according to competing mortality risk and evaluate the impact of this risk on power loss in clinical studies. RESULTS: The 5-year cumulative incidences of all-cause mortality, HNC-specific mortality, and competing mortality were 51.3% (95% CI, 50.8% to 51.9%), 23.8% (95% CI, 23.3% to 24.2%), and 27.6% (95% CI, 26.8% to 28.3%), respectively. Factors associated with increased competing mortality were increasing age, male sex, black race, unmarried status, localized disease, higher socioeconomic status, nonsurgical treatment, and hypopharyngeal, nasopharyngeal, and oral cavity subsites. The 5-year cumulative incidences of competing mortality for patients in low-, medium-, and high-risk score tertiles were 20.0% (95% CI, 18.8% to 21.3%), 27.7% (95% CI, 26.3% to 29.1%), and 33.7% (95% CI, 32.2% to 35.2%), respectively. Compared with patients with low competing mortality risk, relative sample sizes required to show benefit of a treatment regarding all-cause mortality were 12% and 42% higher in the medium- and high-risk groups, respectively. CONCLUSION: Multiple factors affect risk of competing mortality among patients with HNC. Risk stratification would be useful to identify patients most likely to benefit from treatment intensification.
Authors: Loren K Mell; Hanjie Shen; Phuc Felix Nguyen-Tân; David I Rosenthal; Kaveh Zakeri; Lucas K Vitzthum; Steven J Frank; Peter B Schiff; Andy M Trotti; James A Bonner; Christopher U Jones; Sue S Yom; Wade L Thorstad; Stuart J Wong; George Shenouda; John A Ridge; Qiang E Zhang; Quynh-Thu Le Journal: Clin Cancer Res Date: 2019-08-16 Impact factor: 12.531
Authors: Gene-Fu F Liu; Mark C Ranck; Abhishek A Solanki; Hongyuan Cao; Antonia Kolokythas; Barry L Wenig; Lucy Chen; Stephanie Ard; Ralph R Weichselbaum; Howard Halpern; Michael T Spiotto Journal: Cancer Date: 2013-10-10 Impact factor: 6.860
Authors: Paul Riviere; Christopher Tokeshi; Jiayi Hou; Vinit Nalawade; Reith Sarkar; Anthony J Paravati; Melody Schiaffino; Brent Rose; Ronghui Xu; James D Murphy Journal: JCO Clin Cancer Inform Date: 2019-03
Authors: Collin F Mulcahy; Abdallah S R Mohamed; Aasheesh Kanwar; Katherine A Hutcheson; Alokananda Ghosh; David Vock; Randal S Weber; Stephen Y Lai; Gary Brandon Gunn; Mark Zafereo; William H Morrison; Renata Ferrarotto; Adam S Garden; David I Rosenthal; Clifton D Fuller Journal: Head Neck Date: 2018-05-13 Impact factor: 3.147
Authors: Clayton B Hess; Dominique L Rash; Megan E Daly; D Gregory Farwell; John Bishop; Andrew T Vaughan; Machelle D Wilson; Allen M Chen Journal: JAMA Otolaryngol Head Neck Surg Date: 2014-04 Impact factor: 6.223