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01-02-2021 | Head and Neck Oncology

Time to Surgery and Survival in Head and Neck Cancer

Authors: Chandler J. Rygalski, BS, Songzhu Zhao, MS, Antoine Eskander, MD, ScM, Kevin Y. Zhan, MD, Edmund A. Mroz, PhD, Guy Brock, PhD, Dustin A. Silverman, MD, Dukagjin Blakaj, MD, PhD, Marcelo R. Bonomi, MD, Ricardo L. Carrau, MD, MBA, Matthew O. Old, MD, James W. Rocco, MD, PhD, Nolan B. Seim, MD, Sidharth V. Puram, MD, PhD, Stephen Y. Kang, MD

Published in: Annals of Surgical Oncology | Issue 2/2021

Abstract

Background

The COVID-19 pandemic has required triage and delays in surgical care throughout the world. The impact of these surgical delays on survival for patients with head and neck squamous cell carcinoma (HNSCC) remains unknown.

Methods

A retrospective cohort study of 37 730 patients in the National Cancer Database with HNSCC who underwent primary surgical management from 2004 to 2016 was performed. Uni- and multivariate analyses were used to identify predictors of overall survival. Bootstrapping methods were used to identify optimal time-to-surgery (TTS) thresholds at which overall survival differences were greatest. Cox proportional hazard models with or without restricted cubic splines were used to determine the association between TTS and survival.

Results

The study identified TTS as an independent predictor of overall survival (OS). Bootstrapping the data to dichotomize the cohort identified the largest rise in hazard ratio (HR) at day 67, which was used as the optimal TTS cut-point in survival analysis. The patients who underwent surgical treatment longer than 67 days after diagnosis had a significantly increased risk of death (HR, 1.189; 95% confidence interval [CI], 1.122–1.261; P < 0.0001). For every 30-day delay in TTS, the hazard of death increased by 4.6%. Subsite analysis showed that the oropharynx subsite was most affected by surgical delays, followed by the oral cavity.

Conclusions

Increasing TTS is an independent predictor of survival for patients with HNSCC and should be performed within 67 days after diagnosis to achieve optimal survival outcomes.

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Murphy CT, Galloway TJ, Handorf EA, et al. Increasing time to treatment initiation for head and neck cancer: an analysis of the National Cancer Database. Cancer. 2015;121:1204–13. https://doi.org/10.1002/cncr.29191.CrossRefPubMed

Murphy CT, Galloway TJ, Handorf EA, et al. Survival impact of increasing time to treatment initiation for patients with head and neck cancer in the United States. J Clin Oncol. 2016;34:169–78. https://doi.org/10.1200/jco.2015.61.5906.CrossRefPubMed

Cheraghlou S, Kuo P, Judson BL. Treatment delay and facility case volume are associated with survival in early-stage glottic cancer. Laryngoscope. 2017;127:616–22. https://doi.org/10.1002/lary.26259.CrossRefPubMed

Xiao R, Ward MC, Yang K, et al. Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: a mechanism for increased mortality. Cancer. 2018;124:1400–14. https://doi.org/10.1002/cncr.31213.CrossRefPubMed

Ho AS, Kim S, Tighiouart M, et al. Quantitative survival impact of composite treatment delays in head and neck cancer. Cancer. 2018;124:3154–62. https://doi.org/10.1002/cncr.31533.CrossRefPubMedPubMedCentral

Harris JP, Chen MM, Orosco RK, Sirjani D, Divi V, Hara W. Association of survival with shorter time to radiation therapy after surgery for U.S. patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2018;144:349–59. https://doi.org/10.1001/jamaoto.2017.3406CrossRefPubMedPubMedCentral

Graboyes EM, Garrett-Mayer E, Ellis MA, et al. Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer. Cancer. 2017;123:4841–50. https://doi.org/10.1002/cncr.30939.CrossRefPubMedPubMedCentral

Goel AN, Frangos MI, Raghavan G, et al. The impact of treatment package time on survival in surgically managed head and neck cancer in the United States. Oral Oncol. 2019;88:39–48. https://doi.org/10.1016/j.oraloncology.2018.11.021.CrossRefPubMed

Graboyes EM, Kompelli AR, Neskey DM, et al. Association of treatment delays with survival for patients with head and neck cancer: a systematic review. JAMA Otolaryngol Head Neck Surg. 2019;145:166–77. https://doi.org/10.1001/jamaoto.2018.2716.CrossRefPubMedPubMedCentral

10.

Fujiwara RJT, Judson BL, Yarbrough WG, Husain Z, Mehra S. Treatment delays in oral cavity squamous cell carcinoma and association with survival. Head Neck. 2017;39:639–46. https://doi.org/10.1002/hed.24608.CrossRefPubMed

11.

Bilimoria KY, Stewart AK, Winchester DP, Ko CY. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol. 2008;15:683–90. https://doi.org/10.1245/s10434-007-9747-3.CrossRefPubMedPubMedCentral

12.

Zhan KY, Morgan PF, Neskey DM, et al. Preoperative predictors of occult nodal disease in cT1N0 oral cavity squamous cell carcinoma: review of 2623 cases. Head Neck. 2018;40:1967–76. https://doi.org/10.1002/hed.25178.CrossRefPubMed

13.

Zhan KY, Puram SV, Li MM, et al. National treatment trends in human papillomavirus-positive oropharyngeal squamous cell carcinoma. Cancer. Published online 11 December 2019. https://doi.org/10.1002/cncr.32654.%3caq3>

14.

Cracchiolo JR, Baxi SS, Morris LG, et al. Increase in primary surgical treatment of T1 and T2 oropharyngeal squamous cell carcinoma and rates of adverse pathologic features: National Cancer Data Base. Cancer. 2016;122:1523–32. https://doi.org/10.1002/cncr.29938.CrossRefPubMedPubMedCentral

15.

SEER Program Code Manual 3rd ed. rev 1. SEER Field and Code Changes for 2003. Published online 2003:26.

16.

Rosenthal DI, Liu L, Lee JH, et al. Importance of the treatment package time in surgery and postoperative radiation therapy for squamous carcinoma of the head and neck. Head Neck. 2002;24:115–26. https://doi.org/10.1002/hed.10038.CrossRefPubMed

17.

Eskander A, Irish J, Groome PA, et al. Volume-outcome relationships for head and neck cancer surgery in a universal health care system. Laryngoscope. 2014;124:2081–8. https://doi.org/10.1002/lary.24704.CrossRefPubMed

18.

Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37. https://doi.org/10.1056/nejmsa012337.CrossRefPubMed

19.

Wuthrick EJ, Zhang Q, Machtay M, et al. Institutional clinical trial accrual volume and survival of patients with head and neck cancer. JCO. 2014;33:156–64. https://doi.org/10.1200/jco.2014.56.5218.CrossRef

20.

Hollenbeck BK, Dunn RL, Miller DC, Daignault S, Taub DA, Wei JT. Volume-based referral for cancer surgery: informing the debate. J Clin Oncol. 2007;25:91–6. https://doi.org/10.1200/jco.2006.07.2454.CrossRefPubMed

21.

Finlayson EVA, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138:721–725. discussion 726. https://doi.org/10.1001/archsurg.138.7.721CrossRefPubMed

22.

McCahill LE, Privette A, James T, et al. Quality measures for breast cancer surgery: initial validation of feasibility and assessment of variation among surgeons. Arch Surg. 2009;144:455–62; discussion 462–3. https://doi.org/10.1001/archsurg.2009.56CrossRefPubMed

Title: Time to Surgery and Survival in Head and Neck Cancer
Authors: Chandler J. Rygalski, BS
Songzhu Zhao, MS
Antoine Eskander, MD, ScM
Kevin Y. Zhan, MD
Edmund A. Mroz, PhD
Guy Brock, PhD
Dustin A. Silverman, MD
Dukagjin Blakaj, MD, PhD
Marcelo R. Bonomi, MD
Ricardo L. Carrau, MD, MBA
Matthew O. Old, MD
James W. Rocco, MD, PhD
Nolan B. Seim, MD
Sidharth V. Puram, MD, PhD
Stephen Y. Kang, MD
Publication date: 01-02-2021
Publisher: Springer International Publishing
Published in: Annals of Surgical Oncology / Issue 2/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-020-09326-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Time to Surgery and Survival in Head and Neck Cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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