Impact of comorbidity on outcome and treatment choice in patients with head and neck squamous cell carcinoma (HNSCC).
Authors: Giacinti Silvana , Giannarelli Diana , Moi Rossana , Battista Michele , Perfetti Alessandra , Ferrari Laura , Alò Piero Luigi , Costanzo Filippo , Marzetti Andrea , Cognetti Francesco , Nisticò Cecilia 
Published: June 2024

e18033

Background: Most patients (pts) with HNSCC are elderly and suffer from other diseases that, similarly to cancer, are related to smoking and alcohol habit. Therefore, these pts often may present at diagnosis with both comorbidities and other primary tumour with which they share the same risk factors. Several studies have shown that in cancer pts, the presence of comorbidities is a strong negative prognostic factor that can predict worse survival and a factor involved in changing cancer treatment choices. The Charlson Comorbidity Index (CCI) is a known tool for assessing the comorbidity burden of pts, with broad and validated prognostic value in the HNSCC population. Methods: The aim of this study is to retrospectively analyze, in a single cohort of HNSCC pts, the role of comorbidity burden on treatment choice and pts outcome.Data from the medical records of pts treated at Spaziani Hospital, FR, Italy from May 2019 to Jan 2023 for an HNSCC were collected. All pts had received a variable combination of surgery, chemo and radiotherapy for their tumor. All pts were staged according to CCI and divided into four groups of comorbidity burden. Data on treatment choice (trimodal (variable combination of surgery+chemotherapy+radiotherapy) vs non-trimodal) were also recorded for stage III-IVA pts. Results: 54 consecutive pts were enrolled. The disease sites included the oral cavity (14 pts), oropharynx (18 pts), larynx (9 pts), nasal cavity/paranasal sinuses (6 pts), occult primary (4 pts) and hypopharynx (4 pts).Of the 54 pts the 22.2% and 77.8% were female and male, respectively. Most pts (39 pts, 72.2%) had stage III-IVA disease. 35 and 40 pts, respectively received a surgical and nonsurgical primary therapy. 13 pts received a trimodal approach. The median observed PFS was 22.4 months (95% CI: 12.6-32.2). No significant differences in DFS were observed according to age (<65 vs ≥ 65 years, p 0.99), sex (p 0.45), comorbidity burden (CCI 0, CCI 1-2, CCI 3-4, CCI≥5; p 0.99), RT (yes vs no, p 0.90), CT-RT (yes vs no, p 0.62), smoking (p0.91). In our cohort, only an ECOG Performance Status 0 (0 vs ≥1; p 0.028) and HPV status (pos vs neg; p 0.002) were correlated with a better DFS. A high comorbidity burden (CCI score) was present in >85% of pts. In general, those who undergo trimodal treatment among stage III-IV pts are those with PS 0 vs ≥ 1 (40% vs 23.5%), with age < 65 vs ≥65 years (40.0% vs 26.3%), with a CCI ≤1 vs CCI >1 (47.6% vs 16.7%), absence vs presence of CV morbidity (40.6% vs 0%), female vs male (50% vs 27.6%), in the HPV+ vs HPV- (100% vs 25%). Among these, the presence of CV comorbidities (p 0.039), CCI (p 0.041) and HPV (p 0.018) are statistically significant. Conclusions: Our analysis suggests that in pts with Stage III-IVA, the presence of a higher comorbidity burden and CV morbidity are capable of influencing the choice of a trimodal treatment. A broader test is necessary due to the small sample size considered.