title: Role of comorbidity on outcome of head and neck cancer: a population-based study in Thuringia, Germany.
abstract: To examine the impact of comorbidity on overall survival (OS) in a population-based study of patients with head and neck cancer who were treated between 2009 and 2011. Data of 1094 patients with primary head and neck carcinomas without distant metastasis from the Thuringian cancer registries were evaluated concerning the influence of patient's characteristics and comorbidity on OS. Data on comorbidity prior to head and neck cancer diagnosis was adapted to the Charlson Comorbidity (CCI), age-adjusted CCI (ACCI), head and neck CCI (HNCCI), simplified comorbidity score (SCS), and to the Adult Comorbidity Evaluation-27 (ACE-27). Most patients were male (80%; median age: 60 years; 50% stage IV tumors). Smoking, alcohol abuse, and anemia were registered for 38%, 33%, and 23% of the patients, respectively. Predominant therapy was surgery + radiochemotherapy (30%), surgery (29%), and surgery + radiotherapy (21%). Mean CCI, ACCI, HNCCI, SCS and ACE-27 were 1.0 ± 1.5, 2.6 ± 2.1, 0.6 ± 0.8, 4.4 ± 4.2, and 0.9 ± 0.9, respectively. Median follow-up was 25.7 months. Multivariable analyses showed that higher age, higher UICC stage, no therapy, including surgery or radiotherapy, alcohol abuse, and anemia, higher comorbidity were independent risk factors for worse OS (all P < 0.05). According to the discriminatory power analysis none of the five comorbidity scores was superior to the other scores to prognosticate OS. This population-based study showed that comorbidity is frequent in German patients with head and neck cancer and is an important risk factor for poor OS. Comorbidity should be routinely assessed and taken into account in prospective clinical trials.
authors.affiliation: Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
authors.forename: Irene
authors.initials: I
authors.lastname: Göllnitz
authors.affiliation: Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
authors.forename: Johanna
authors.initials: J
authors.lastname: Inhestern
authors.affiliation: Department of Radiooncology, Jena University Hospital, Jena, Germany.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Wendt
authors.affiliation: Department of Otorhinolaryngology, Suedharzkrankenhaus Nordhausen, Nordhausen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Buentzel
authors.affiliation: Department of Otorhinolaryngology, Helios-Klinikum Erfurt, Erfurt, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Esser
authors.affiliation: Department of Otorhinolaryngology, SRH Zentralklinikum Suhl, Suhl, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Böger
authors.affiliation: Department of Otorhinolaryngology, SRH Wald-Klinikum Gera, Gera, Germany.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Mueller
authors.affiliation: Department of Oromaxillofacial Surgery, Helios-Klinikum Erfurt, Erfurt, Germany.
authors.forename: Jörn-Uwe
authors.initials: JU
authors.lastname: Piesold
authors.affiliation: Department of Oromaxillofacial Surgery and Plastic Surgery, Jena University Hospital, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schultze-Mosgau
authors.affiliation: University Tumor Center, Jena University Hospital, Jena, Germany.
authors.forename: Ekkehard
authors.initials: E
authors.lastname: Eigendorff
authors.affiliation: Department of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.affiliation: Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.
authors.forename: Orlando
authors.initials: O
authors.lastname: Guntinas-Lichius
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012042:Registries
keywords: Cancer registry; Charlson comorbidity index; comorbidity; epidemiology; head and neck cancer; head and neck specific comorbidity index; risk; survival