Daniele Borsetto1, Mantegh Sethi1, Jerry Polesel2, Michele Tomasoni3, Alberto Deganello3, Piero Nicolai3, Paolo Bossi4, Cristoforo Fabbris5, Gabriele Molteni5, Daniele Marchioni5, Margherita Tofanelli6, Fiordaliso Cragnolini6, Giancarlo Tirelli6, Andrea Ciorba7, Stefano Pelucchi7, Virginia Corazzi7, Pietro Canzi8, Marco Benazzo8, Valentina Lupato9, Vittorio Giacomarra9, Diego Cazzador10, Luigia Bandolin10, Anna Menegaldo11, Giacomo Spinato11, Rupert Obholzer1, Jonathan Fussey12, Paolo Boscolo-Rizzo6,11. 1. Department of ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 2. Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy. 3. Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy. 4. Department of Medical Oncology, Medical Oncology Unit, ASST Spedali Civili di Brescia, Brescia, Italy. 5. Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Section of Ear Nose and Throat (ENT), University of Verona, Verona, Italy. 6. Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy. 7. ENT Department, University Hospital of Ferrara, Ferrara, Italy. 8. Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico 'San Matteo' Foundation, Pavia, Italy. 9. Unit of Otolaryngology, Azienda Ospedaliera 'S. Maria degli Angeli', Pordenone, Italy. 10. Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy. 11. Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy. 12. Department of ENT, New Cross Hospital, Wolverhampton, UK.
Abstract
BACKGROUND: Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) experience locoregional recurrence, which is associated with poor outcome. In the course of follow-up for patients surviving primary surgery for HNSCC, one might ask: What is the probability of recurrence in one year considering that the cancer has not yet recurred to date? MATERIALS AND METHODS: To answer this question, 979 patients surgically treated for HNSCC (i.e. cancer of the oral cavity, oropharynx, hypopharynx or larynx) between March 2004 and June 2018 were enrolled in a multicenter retrospective cohort study, followed up for death and recurrence over a 5 year period. The conditional probability of recurrence in 12 months - i.e. the probability of recurrence in the next 12 months given that, to date, the patient has not recurred - was derived from the cumulative incidence function (Aalen-Johansen method). RESULTS: Overall, the probability of recurrence was the highest during the first (17.3%) and the second years (9.6%) after surgery, declining thereafter to less than 5.0% a year thereafter. The probability of recurrence was significantly higher for stage III-IV HNSCCs than for stage I-II HNSCCs in the first year after surgery (20.4% versus 10.0%; p < 0.01), but not thereafter. This difference was most pronounced for oral cavity cancers. No significant differences were observed across different tumor sites. CONCLUSION: This dynamic evaluation of recurrence risk in patients surgically treated for HNSCC provides helpful and clinically meaningful information, which can be useful to patients in planning their future life, and to clinicians in tailoring post-treatment surveillance according to a more personalized risk stratification.
BACKGROUND: Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) experience locoregional recurrence, which is associated with poor outcome. In the course of follow-up for patients surviving primary surgery for HNSCC, one might ask: What is the probability of recurrence in one year considering that the cancer has not yet recurred to date? MATERIALS AND METHODS: To answer this question, 979 patients surgically treated for HNSCC (i.e. cancer of the oral cavity, oropharynx, hypopharynx or larynx) between March 2004 and June 2018 were enrolled in a multicenter retrospective cohort study, followed up for death and recurrence over a 5 year period. The conditional probability of recurrence in 12 months - i.e. the probability of recurrence in the next 12 months given that, to date, the patient has not recurred - was derived from the cumulative incidence function (Aalen-Johansen method). RESULTS: Overall, the probability of recurrence was the highest during the first (17.3%) and the second years (9.6%) after surgery, declining thereafter to less than 5.0% a year thereafter. The probability of recurrence was significantly higher for stage III-IV HNSCCs than for stage I-II HNSCCs in the first year after surgery (20.4% versus 10.0%; p < 0.01), but not thereafter. This difference was most pronounced for oral cavity cancers. No significant differences were observed across different tumor sites. CONCLUSION: This dynamic evaluation of recurrence risk in patients surgically treated for HNSCC provides helpful and clinically meaningful information, which can be useful to patients in planning their future life, and to clinicians in tailoring post-treatment surveillance according to a more personalized risk stratification.
Entities:
Keywords:
Head and neck cancers; conditional probability; recurrence; squamous cell carcinoma; survival