Risk factors for early mortality and impaired quality of life in oral cavity cancer – head and neck cancer register study
DOI:
https://doi.org/10.2340/1651-226X.2025.43469Keywords:
Surgery, risk factors, mortality, curative-intent, health-related quality of life, EORTC QLQ-H&N35Abstract
Background and purpose: Treatment of locoregionally advanced oral cavity cancer (OCC) is associated with treatment-related complications, functional deficits, and even early mortality. High-quality register data could help in choosing between curative and non-curative intent treatment options.
Materials and methods: The Helsinki Head and Neck Cancer Register (HHNCR) is linked with the EORTC QLQ-H&N35 questionnaire automatically sent to all patients at diagnosis and predetermined intervals. We analyzed pretreatment data of all patients diagnosed with OCC during 2018–2023, focusing on risk factors for early mortality and impaired health-related quality of life after curative-intent treatment.
Results: Of 597 patients, 556 (93%) were treated with curative intent. Thirty-nine (7.0%) patients died within 6 months after diagnosis. The independent risk-factors for 6-month mortality identified in multivariable analysis were T3 stage (OR 8.3 [2.6–26.5], p < 0.001), T4 stage (OR 8.2 [2.5–26.8], p < 0.001), N3 stage (OR 10.6 [3.2–35.1], p < 0.001), and Adult Comorbidity Evaluation (ACE)-27 score 2–3 (OR 5.5 [2.4–12.5], p < 0.001). These risk-factors were used to create a predictive risk score for early death. Younger, healthier patients had significantly higher EORTC QLQ-H&N35 response rates compared with older patients with comorbidities. Six months after diagnosis, patients with a stage III–IV tumor had significantly higher scores in 15 of 18 items, compared with patients with a stage I–II tumor.
Interpretation: Early mortality was associated with advanced tumor (T) and nodal (N) stage, and increased pretreatment comorbidity (ACE-27) scores. The strongest predictor for impaired quality of life was locoregionally advanced disease.
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Copyright (c) 2025 Teija Nieminen, Morag Tolvi, Tuija Ylä-Kotola, Lasse Lehtonen, Antti Mäkitie, Taru Ilmarinen
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