Causes of long-term mortality in patients with head and neck squamous cell carcinomas.

PURPOSE: After treatment of a head and neck squamous cell carcinoma (HNSCC), patients with an adequate control of the tumor have a decreased overall survival when compared to age- and gender-matched controls in the general population. The aim of our study was to analyze the causes of long-term mortality in patients with HNSCC. METHODS: We carried out a retrospective study of 5122 patients with an index HNSCC treated at our center between 1985 and 2018. We analyzed the survival considering three causes of death: mortality associated with the HNSCC index tumor, mortality associated with a second or successive neoplasm, and mortality associated with a non-cancer cause. RESULTS: After the diagnosis of an HNSCC the most frequent cause of death is the head and neck tumor itself during the first 3.5 years of follow-up. Thereafter, mortality is more frequently associated with competing causes of death, such as second malignancies and non-cancer causes. Mortality associated with second and successive neoplasms was 2.3% per year, a percentage that was maintained constant throughout the follow-up. Likewise, mortality attributable to non-cancer causes was 1.6% per year, which also remained constant. There were differences in the mortality patterns according to the characteristics of the patients. CONCLUSION: There are differences in the mortality patterns of patients with HNSCC depending on their characteristics. Knowledge of these patterns can help in the design of guidelines to improve the follow-up protocols of this group of patients to optimize the clinical cost-effectiveness.

Prognostic capacity of PIV (pan-immune-inflammation value) in patients with head and neck squamous cell carcinoma.

INTRODUCTION: The pan-immune-inflammation value (PIV), an index that results from the following ratio: (neutrophils × monocytes × platelets)/lymphocytes, has been proposed as a prognostic biomarker in different tumour models. The aim of this study is to analyse the prognostic capacity of PIV in patients with head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS: Retrospective study of 1187 patients with HNSCC treated at our centre between 2000-2017. PIV value was obtained from an analysis performed within 3 weeks prior to the start of treatment. RESULTS: PIV value was significantly associated with toxic consumption (0.001), tumour location (0.0001), tumour extension (0.0001), and histological grade (0.016). Four categories were defined based on PIV value using a recursive partitioning analysis: category I: PIV < 136.3 (n = 118, 9.9%), category II: PIV 136.3-451.1 (n = 594, 50.0%), category III: PIV 451.1-1,141.2 (n = 357, 30.1%), and category IV: PIV > 1141.2 (n = 118, 9.9%). A significant and ordered decrease in disease-specific survival was observed as the PIV category increased. This decrease in survival was independent of the type of treatment, tumour extension, or location of the primary tumour. The PIV category was and independent prognostic factor of disease-specific survival in a multivariable study. CONCLUSIONS: PIV is a prognostic biomarker in patients with HNSCC.

Differential characteristics of patients with squamous cell carcinoma of the head and neck with no history of tobacco or alcohol use.

OBJECTIVE: The present study aims to analyse the differential characteristics of patients with head and neck squamous cell carcinoma (HNSCC) without a history of consumption of toxic substances such as tobacco and alcohol. MATERIAL AND METHODS: We carried out a retrospective study of 4694 patients with HNSCC located in the oral cavity, oropharynx, hypopharynx or larynx treated in our centre during the period 1985-2019. RESULT: 7.7% of the patients (n = 363) did not report a history of consumption of toxic substances. The group of patients with no toxic history was older, had a higher proportion of women, a higher frequency of cases located in the oral cavity, a higher proportion of cases diagnosed in early stages, and a lower incidence of second neoplasms. The percentage of patients with no history of consumption of toxic substances increased significantly over the study period. The overall survival of patients with no history of consumption of toxic substances was significantly higher than that of patients with toxic substances use. Specific survival for patients with tumours located in the oral cavity without a history of consumption of toxic substances was significantly lower than that of patients with toxic substances use, whereas for patients with oropharyngeal carcinomas the absence of a history of consumption of toxic substances was associated with a better prognosis. CONCLUSIONS: There were differences in the epidemiological and prognostic characteristics of patients with HNSCC according to the history of consumption of toxic substances such as tobacco and alcohol.

Second esophageal neoplasms after head and neck index tumor: Incidence, risk factors and prognosis.

OBJECTIVE: Patients with head and neck squamous cell carcinoma (HNSCC) have an increased risk of second esophageal neoplasms. The aim of the present study is to evaluate the incidence, risk factors and prognosis of second esophageal neoplasms in patients with HNSCC. METHODS: A retrospective study of 4711 patients with index tumor in the oral cavity, oropharynx, hypopharynx or larynx between 1985 and 2020 was conducted. RESULTS: During the period analysed 149 patients (3.2%) had a second esophageal neoplasm. The incidence of second esophageal neoplasia was 0.42% per year and remained nearly constant throughout the follow-up period. According to the results of a multivariate study, the risk factors related to the appearance of second esophageal neoplasms were a history of high alcohol consumption and the location of the primary tumor in the oropharynx or hypopharynx. The 5-year disease-specific survival rate in patients with a second esophageal neoplasm, calculated from the diagnosis of this second neoplasm, was 10.5%. CONCLUSIONS: Patients with a HNSCC have an increased risk of developing of a second esophageal neoplasm. The risk factors associated with the appearance of a second esophageal neoplasm were severe alcohol consumption and the location of the primary tumor in the oropharynx or hypopharynx.