Head and neck squamous cell carcinoma: Better to be young

Most head and neck squamous cell carcinoma patients are elderly, with few y ounger than 40 years. Controversy exists in the literature regarding outcom es for younger patients. The goal of this research project was to compare b aseline features and outcomes for young patients (less than or equal to 40 years), middle-aged patients (41-64 years), and old patients (greater than or equal to 65 years). To investigate the relationship between age and impo rtant presenting features and outcomes, 1160 recently diagnosed patients fi rst treated at Washington University between 1980 and 1991 were identified from an existing database. Full 5-year survival information was available f or 1030 patients (89%), Overall. the 5-year survival rate was 46% (478/1030 ); young patients (65%, 26/40) had a significantly better survival rate tha n middle-aged (52%, 292/566) or old patients (38%, 160/424) (chi(2) = 24.5; P = 0.001), Survival was also related to smoking, comorbidity, primary sit e, TNM stage, and nodal disease. Age remained a significant factor even aft er we controlled for these other factors. Young patients developed fewer re current and new primary tumors. We conclude that young patients have a much better overall prognosis than older patients. The reasons for this differe nce are unclear, but it appears that the impact of age goes beyond an actua rial effect.