Selection of ideal candidates for surgical salvage of head and neck squamous cell carcinoma

Effect of the charlson-age comorbidity index and oncologic characteristics on 1-year survival and hospital course

Jee Hong Kim, Seungwon Kim, William Greer Albergotti, Phillip A. Choi, Daniel James Kaplan, Shira Abberbock, Jonas T. Johnson, Neil Gildener-Leapman

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

IMPORTANCE Salvage surgery for recurrent head and neck squamous cell carcinoma (HNSCC) carries substantial risks of morbidity and mortality. Risk factors for death within 1 year should be better defined. OBJECTIVES To report preoperative oncologic prognostic factors predictive of short-term (<1 year) survival after salvage surgery in patients with HNSCC, to assess whether preoperative age and comorbidity predicts 1-year mortality, and to report hospital courses after salvage surgery within 1 year. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of 191 patients with recurrent HNSCC treated with salvage surgery from January 1, 2003, through December 31, 2013, at a tertiary academic center. INTERVENTIONS Surgical salvage of HNSCC (larynx, oral cavity, oropharynx, or hypopharynx) with curative intent. MAIN OUTCOMES AND MEASURES Primary outcomewas survival 1 year after salvage surgery. Secondary outcomeswere length of inpatient hospital stay, days of admissions, and skilled nursing facility disposition within 1 year stratified by survival status. Presalvage Charlson-Age Comorbidity Index (CACI)was calculated. Associations among CACI, oncologic risk factors, and risk of death within 1 year after salvage surgery are investigated using multivariable analysis. RESULTS Of 191 patients studied, 53 (27.7%) died within 1 year after salvage surgery. Patients who died within 1 year had more total inpatient admissions (P <.001), longer total length of stay (P <.001), and higher risk of discharge to a skilled nursing facility (P <.001) and spent 17.3%(interquartile range, 5.2-36.3) of their remaining days in the hospital. Independent risk factors for death within 1 year are CACI (relative risk [RR], 1.43; 95%CI, 1.16-1.76), primary T3 or T4 stage (RR, 2.34; 95%CI, 1.27-4.31), and disease-free interval of less than 6 months (RR, 5.61; 95%CI, 1.78-16.7). CONCLUSIONS AND RELEVANCE Medical comorbidity and age as measured by the CACI, primary T3 or T4 stage, and short disease-free interval must be considered in selecting patients ideal for surgical salvage surgery for recurrent HNSCC. Patients with these risk factors should be more strongly considered for palliative measures.

Original languageEnglish (US)
Pages (from-to)1059-1065
Number of pages7
JournalJAMA Otolaryngology - Head and Neck Surgery
Volume141
Issue number12
DOIs
StatePublished - Dec 1 2015
Externally publishedYes

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Comorbidity
Survival
Skilled Nursing Facilities
Inpatients
Length of Stay
Hypopharynx
Oropharynx
Mortality
Carcinoma, squamous cell of head and neck
Larynx
Medical Records
Mouth
Morbidity

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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Selection of ideal candidates for surgical salvage of head and neck squamous cell carcinoma : Effect of the charlson-age comorbidity index and oncologic characteristics on 1-year survival and hospital course. / Kim, Jee Hong; Kim, Seungwon; Albergotti, William Greer; Choi, Phillip A.; Kaplan, Daniel James; Abberbock, Shira; Johnson, Jonas T.; Gildener-Leapman, Neil.

In: JAMA Otolaryngology - Head and Neck Surgery, Vol. 141, No. 12, 01.12.2015, p. 1059-1065.

Research output: Contribution to journalArticle

Kim, Jee Hong ; Kim, Seungwon ; Albergotti, William Greer ; Choi, Phillip A. ; Kaplan, Daniel James ; Abberbock, Shira ; Johnson, Jonas T. ; Gildener-Leapman, Neil. / Selection of ideal candidates for surgical salvage of head and neck squamous cell carcinoma : Effect of the charlson-age comorbidity index and oncologic characteristics on 1-year survival and hospital course. In: JAMA Otolaryngology - Head and Neck Surgery. 2015 ; Vol. 141, No. 12. pp. 1059-1065.
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abstract = "IMPORTANCE Salvage surgery for recurrent head and neck squamous cell carcinoma (HNSCC) carries substantial risks of morbidity and mortality. Risk factors for death within 1 year should be better defined. OBJECTIVES To report preoperative oncologic prognostic factors predictive of short-term (<1 year) survival after salvage surgery in patients with HNSCC, to assess whether preoperative age and comorbidity predicts 1-year mortality, and to report hospital courses after salvage surgery within 1 year. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of 191 patients with recurrent HNSCC treated with salvage surgery from January 1, 2003, through December 31, 2013, at a tertiary academic center. INTERVENTIONS Surgical salvage of HNSCC (larynx, oral cavity, oropharynx, or hypopharynx) with curative intent. MAIN OUTCOMES AND MEASURES Primary outcomewas survival 1 year after salvage surgery. Secondary outcomeswere length of inpatient hospital stay, days of admissions, and skilled nursing facility disposition within 1 year stratified by survival status. Presalvage Charlson-Age Comorbidity Index (CACI)was calculated. Associations among CACI, oncologic risk factors, and risk of death within 1 year after salvage surgery are investigated using multivariable analysis. RESULTS Of 191 patients studied, 53 (27.7{\%}) died within 1 year after salvage surgery. Patients who died within 1 year had more total inpatient admissions (P <.001), longer total length of stay (P <.001), and higher risk of discharge to a skilled nursing facility (P <.001) and spent 17.3{\%}(interquartile range, 5.2-36.3) of their remaining days in the hospital. Independent risk factors for death within 1 year are CACI (relative risk [RR], 1.43; 95{\%}CI, 1.16-1.76), primary T3 or T4 stage (RR, 2.34; 95{\%}CI, 1.27-4.31), and disease-free interval of less than 6 months (RR, 5.61; 95{\%}CI, 1.78-16.7). CONCLUSIONS AND RELEVANCE Medical comorbidity and age as measured by the CACI, primary T3 or T4 stage, and short disease-free interval must be considered in selecting patients ideal for surgical salvage surgery for recurrent HNSCC. Patients with these risk factors should be more strongly considered for palliative measures.",
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AU - Kim, Seungwon

AU - Albergotti, William Greer

AU - Choi, Phillip A.

AU - Kaplan, Daniel James

AU - Abberbock, Shira

AU - Johnson, Jonas T.

AU - Gildener-Leapman, Neil

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N2 - IMPORTANCE Salvage surgery for recurrent head and neck squamous cell carcinoma (HNSCC) carries substantial risks of morbidity and mortality. Risk factors for death within 1 year should be better defined. OBJECTIVES To report preoperative oncologic prognostic factors predictive of short-term (<1 year) survival after salvage surgery in patients with HNSCC, to assess whether preoperative age and comorbidity predicts 1-year mortality, and to report hospital courses after salvage surgery within 1 year. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of 191 patients with recurrent HNSCC treated with salvage surgery from January 1, 2003, through December 31, 2013, at a tertiary academic center. INTERVENTIONS Surgical salvage of HNSCC (larynx, oral cavity, oropharynx, or hypopharynx) with curative intent. MAIN OUTCOMES AND MEASURES Primary outcomewas survival 1 year after salvage surgery. Secondary outcomeswere length of inpatient hospital stay, days of admissions, and skilled nursing facility disposition within 1 year stratified by survival status. Presalvage Charlson-Age Comorbidity Index (CACI)was calculated. Associations among CACI, oncologic risk factors, and risk of death within 1 year after salvage surgery are investigated using multivariable analysis. RESULTS Of 191 patients studied, 53 (27.7%) died within 1 year after salvage surgery. Patients who died within 1 year had more total inpatient admissions (P <.001), longer total length of stay (P <.001), and higher risk of discharge to a skilled nursing facility (P <.001) and spent 17.3%(interquartile range, 5.2-36.3) of their remaining days in the hospital. Independent risk factors for death within 1 year are CACI (relative risk [RR], 1.43; 95%CI, 1.16-1.76), primary T3 or T4 stage (RR, 2.34; 95%CI, 1.27-4.31), and disease-free interval of less than 6 months (RR, 5.61; 95%CI, 1.78-16.7). CONCLUSIONS AND RELEVANCE Medical comorbidity and age as measured by the CACI, primary T3 or T4 stage, and short disease-free interval must be considered in selecting patients ideal for surgical salvage surgery for recurrent HNSCC. Patients with these risk factors should be more strongly considered for palliative measures.

AB - IMPORTANCE Salvage surgery for recurrent head and neck squamous cell carcinoma (HNSCC) carries substantial risks of morbidity and mortality. Risk factors for death within 1 year should be better defined. OBJECTIVES To report preoperative oncologic prognostic factors predictive of short-term (<1 year) survival after salvage surgery in patients with HNSCC, to assess whether preoperative age and comorbidity predicts 1-year mortality, and to report hospital courses after salvage surgery within 1 year. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of 191 patients with recurrent HNSCC treated with salvage surgery from January 1, 2003, through December 31, 2013, at a tertiary academic center. INTERVENTIONS Surgical salvage of HNSCC (larynx, oral cavity, oropharynx, or hypopharynx) with curative intent. MAIN OUTCOMES AND MEASURES Primary outcomewas survival 1 year after salvage surgery. Secondary outcomeswere length of inpatient hospital stay, days of admissions, and skilled nursing facility disposition within 1 year stratified by survival status. Presalvage Charlson-Age Comorbidity Index (CACI)was calculated. Associations among CACI, oncologic risk factors, and risk of death within 1 year after salvage surgery are investigated using multivariable analysis. RESULTS Of 191 patients studied, 53 (27.7%) died within 1 year after salvage surgery. Patients who died within 1 year had more total inpatient admissions (P <.001), longer total length of stay (P <.001), and higher risk of discharge to a skilled nursing facility (P <.001) and spent 17.3%(interquartile range, 5.2-36.3) of their remaining days in the hospital. Independent risk factors for death within 1 year are CACI (relative risk [RR], 1.43; 95%CI, 1.16-1.76), primary T3 or T4 stage (RR, 2.34; 95%CI, 1.27-4.31), and disease-free interval of less than 6 months (RR, 5.61; 95%CI, 1.78-16.7). CONCLUSIONS AND RELEVANCE Medical comorbidity and age as measured by the CACI, primary T3 or T4 stage, and short disease-free interval must be considered in selecting patients ideal for surgical salvage surgery for recurrent HNSCC. Patients with these risk factors should be more strongly considered for palliative measures.

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