A matched control study of treatment outcome in young patients with squamous cell carcinoma of the head and neck

Objectives/Hypothesis: To determine if there is a difference in overall sur vival, cause-specific survival, and relapse-free rate between young patient s (<40 years of age) with head and neck squamous cell carcinoma (HNSCC) and older patients (>40 years of age). Study design: A matched control study d escribing the outcome of 185 previously untreated HNSCC patients less than 40 years of age treated at the Princess Margaret Hospital, Toronto, Ontario , Canada, between 1958 and 1992, The young patient group was compared with a control group of older patients (> 40 years of age) which was selected ra ndomly from an entire cohort of patients (n = 10,072) and matched for site, sex, and date of presentation. Methods: The medical records were reviewed and data abstracted for demographic information, tobacco and alcohol use, f amily history, primary site, clinical stage, primary treatment, histology, the occurrence of residual or recurrent disease, salvage treatment, develop ment of subsequent primaries, survival, and the eventual cause of death. Th e patient's TNM stage was reclassified according to American Joint Cancer C ommittee/Union Internationale Contre le Cancer (AJCC/UICC) 1992 criteria on the basis of the initial clinical description and staging investigations, A multivariate regression analysis was performed. To assess the importance of age as a prognostic factor for survival, the Cox proportion hazard model was used, Smoking status was also tested in the stratified Cox proportiona l hazard model. Results: Tumor stage and treatment modalities were comparab le in both groups. The 5-year, cause-specific survival in both groups was n ot statistically different (72% vs. 68%, P = .91). The young patient group had a significantly better 5-year overall survival compared with the older patient group (68% vs. 49%, P = .0011), Older patients developed more subse quent primary neoplasms than the younger patient population (18% vs. 8%, P = .005), There were significantly more females, an increased incidence of o ral or oropharyngeal cancer, and fewer smokers in the young patient group. Smoking, however, had an important impact on outcome with all but one patie nt who developed a second primary in the upper aerodigestive tract having s moked. Multivariate analysis showed that only disease stage and cancer site were significant prognostic factors for survival, Conclusions: Young patie nts with HNSCC do not have a worse prognosis than a matched older patient g roup in this case-controlled study (power > 0.75 for a minimal detectable d ifference of 10% disease-free survival between the two groups).