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Cancer-Specific Mortality and Competing Mortality in Patients with Head and Neck Squamous Cell Carcinoma: A Competing Risk Analysis

  • Head and Neck Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The objective of this study was to estimate probabilities of cancer-specific death and competing death for patients with head and neck squamous cell carcinoma (HNSCC). In addition, we attempted to construct competing risk nomograms to predict prognosis for patients with HNSCC using a large population-based cohort.

Methods

Patients diagnosed with nonmetastatic HNSCC between 2000 and 2010 were identified from the Surveillance Epidemiology and End Results Program to form the analytic cohort. We estimated cumulative incident function (CIF) of cancer-specific mortality and competing mortality. Nomograms for predicting probability of death were built with proportional subdistribution hazard models.

Results

The study cohort included 23,494 patients with HNSCC. The 5-year CIF for cancer-specific death and competing death were 26.7 % (95 % confidence interval [CI] 26–27.3 %) and 12.7 % (95 % CI 12.2–13.3 %), respectively; 10-year CIF were 32.8 % (95 % CI 31.9–33.6 %) and 23 % (95 % CI 22.1–24 %), respectively. On multivariate analysis, increasing cause-specific mortality was associated with increasing age, increasing tumor size, black race, single status, advanced T and N classifications, and high tumor grade. Increasing probability of competing mortality had a relationship with increasing age, male, black race, single status and nonradiotherapy. Models showed good accuracy with c-index of 0.73 for cause-specific mortality model and 0.69 for competing mortality model.

Conclusions

We constructed competing risk nomograms for HNSCC using population-based data. The model used for building nomograms represented good performance. These nomograms can serve to guide management of patients with HNSCC.

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Acknowledgment

The authors thank Dr. Wolbers for providing guidance in calculating the c-index. The authors also thank SEER for open access to their database.

Disclosure

None.

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Authors and Affiliations

  1. The Institute of Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Chinese PLA General Hospital, Beijing, China

    Weidong Shen MD, PhD

  2. Department of Public Health, Juntendo University, Tokyo, Japan

    Naoko Sakamoto PhD

  3. Epidemiology and Clinical Research Center for Children’s Cancer, National Center for Child Health and Development, Tokyo, Japan

    Limin Yang MD, PhD

  4. Medical Support Center for Japan Environment and Children’s Study (JECS), National Center for Child Health and Development, Tokyo, Japan

    Limin Yang MD, PhD

Authors
  1. Weidong Shen MD, PhD
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  2. Naoko Sakamoto PhD
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  3. Limin Yang MD, PhD
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Corresponding author

Correspondence to Limin Yang MD, PhD.

Additional information

Weidong Shen and Limin Yang have contributed equally to this work.

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Shen, W., Sakamoto, N. & Yang, L. Cancer-Specific Mortality and Competing Mortality in Patients with Head and Neck Squamous Cell Carcinoma: A Competing Risk Analysis. Ann Surg Oncol 22, 264–271 (2015). https://doi.org/10.1245/s10434-014-3951-8

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  • DOI: https://doi.org/10.1245/s10434-014-3951-8

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