title: Comorbidity, human papillomavirus infection and head and neck cancer survival in an ethnically diverse population.
abstract: OBJECTIVE
  To demonstrate the importance of comorbid conditions in head and neck squamous cell carcinoma (HNSCC), we assessed the association between comorbidity and survival in an inner-city population of HNSCC patients.
  
  
  METHODS
  Comorbid status at diagnosis was derived using medical records and the Adult Comorbidity Evaluation-27 (ACE-27) index on 288 patients with histologically confirmed HNSCC from Montefiore Medical Center in the Bronx (NY) between 2002 and 2011. The association between comorbidity, tumor human papillomavirus (HPV) status and overall and disease specific survival was assessed by Kaplan-Meier analysis and multivariable Cox regression adjusting for clinico-pathologic factors.
  
  
  RESULTS
  The study population consisted of primary oropharyngeal (36%), laryngeal (33%) and oral cavity cancer patients (31%). Overall, 19% had no comorbidity, 43% mild comorbidity, 29% moderate comorbidity, and 9% severe comorbidity. The most common comorbid conditions were hypertension, diabetes mellitus, respiratory disease, other malignancies, and illicit drug use. Survival analyses revealed that increased comorbidity at diagnosis was significantly related to poorer overall survival (p=0.016), but not to cancer survival (p=0.369) or recurrence (p=0.652). Oropharyngeal cancer patients with HPV DNA positive tumors and lower levels of comorbidity had significantly better overall survival compared to patients with HPV negative tumors (hazard ratio=0.2, 95%CI: 0.04-0.8), however there was no significant difference in overall (or disease specific) survival by HPV status among patients with higher levels of comorbidity at diagnosis (hazard ratio=0.7, 95%CI: 0.2-2.8).
  
  
  CONCLUSIONS
  In an inner-city predominantly minority population, comorbidity at HNSCC diagnosis is relatively common and associated with poor overall survival, but not cancer survival or recurrence. Interestingly, the relationship between HPV and improved survival appears to be specific to patients with low comorbidity at diagnosis.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10461, United States.
authors.forename: Ashish A
authors.initials: AA
authors.lastname: Ankola
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, United States.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Smith
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Obstetrics, Gynecology & Women's Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
authors.affiliation: Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461, United States.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Prystowsky
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY 10461, United States.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sarta
authors.affiliation: Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States; Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, United States. Electronic address: nicolas.schlecht@einstein.yu.edu.
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Schlecht
mesh_terms: D015897:Comorbidity; D018864:Cultural Diversity; D005006:Ethnicity; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000150:complications* / Q000503:physiopathology; D015996:Survival Rate
keywords: ACE-27; Comorbidity; Head and neck; Human papillomavirus; Oropharyngeal; Squamous cell carcinoma; Survival
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