SAN FRANCISCO—Most patients with squamous cell carcinoma (SqCC) of the head and neck are elderly, and this group has been well represented in studies of the disease, which generally include few patients under the age of 40, said Peter Lacy, MB, FRCSI, a fellow at the Clinical Outcomes Research Office, Washington University Medical Center (WUMC), St. Louis.
Because there are relatively fewer young SqCC patients, they have been much less well-studied and their outcomes remain more controversial, Dr. Lacy said at the 101st Annual Meeting of the American Academy of Otolaryn-gology-Head and Neck Surgery.
The controversy in the literature regarding outcome in younger patients persists because many of the existing studies comparing young and old SqCC patients had small sample size and problems in methodology, he said, adding that many lacked appropriate statistical analysis.
Dr. Lacy and Jay Piccirillo, MD, headed a team that retrospectively reviewed 1,153 WUMC patients treated for SqCC of the head and neck between 1980 and 1992. They then compared two study populations: 44 “young” patients, 40 years old or younger at time of treatment, and 470 “old” patients, 65 years or older when treated.
The results show that younger patients are more likely to have oral cavity or oropharyngeal cancers and more nodal disease, but significantly less comorbid ailments. Older patients had more recurrent disease, 34% versus 23% for younger patients, but the difference was not statistically significant, Dr. Lacy said.
Better Prognosis
The two-year survival rates for the two groups were similar, but there was a marked difference in the five-year survival rates, 70% for younger patients against 39% for older patients. “We conclude that younger patients with head and neck SqCC have a better prognosis,” he said. The differ-ences in survival, he added, remain significant even after controlling for comorbidity, anatomic site, TNM stage, and treatment received.
Overall, Dr. Lacy said, combined surgical and radiation treatments were the most effective in both age groups. The only predictor for recurrence was the presence of nodal disease, irrespective of the age of the patient.
Analysis of the two groups showed that younger patients were 3.5 times more likely to survive their cancer than were older patients. The older patients, in turn, were 4.4 times more likely to develop new primary disease following their initial diagnosis and treatment.
Possible Explanations
Why younger patients with head and neck SqCC do better is not clear, Dr. Lacy noted. Younger patients may have a stronger immune response and fight the disease more effectively than older patients.
It is also possible, he said, that younger patients have simply encountered and endured fewer of the risk factors thought to contribute to SqCC than have their older counterparts.
Younger patients could fare better because of factors that lead to a faster functional recovery than older patients are capable of, Dr. Lacy added. Whatever the reason, he concluded, “age maintains its independent prognostic significance.”
