Pediatric head and neck squamous cell carcinoma: Patient demographics, treatment trends and outcomes.

OBJECTIVES: To examine patient demographics, temporal and treatment trends, and survival outcomes of pediatric non-nasopharyngeal head and neck squamous cell carcinomas using the National Cancer Database. METHODS: The National Cancer Database was queried for pediatric patients (age 0-19 years) diagnosed with squamous cell carcinoma of the head and neck (including oral cavity, oropharynx, nasal cavity, larynx, hypopharynx, and salivary glands) from 2004 to 2013. RESULTS: Of 159 patients identified, the majority had oral cavity SCC (55%). There was no discernable change in incidence trends over the study period with the number of cases per year ranging from 10 to 20 (R2 = 0.174). The predominant treatment regimen for the nasal cavity was trimodality (surgery, radiation, and chemotherapy) treatment (29%), chemotherapy and radiation for the oropharynx (40%), and surgery alone for salivary gland (47%), oral cavity (44%), and larynx (22%). The 5-year overall survival for the entire cohort was 74% and by subsite: oral cavity (66%), oropharynx (68%), nasal cavity (75%), and larynx (95%). Laryngeal disease had statistically significant longer survival when compared to oral cavity (p = .031) or oropharynx (p = .029). CONCLUSION: Although pediatric non-nasopharyngeal head and neck squamous cell carcinomas are rare, practitioners should be aware of this entity and consider it in the differential diagnosis of pediatric malignancies.

Oropharyngeal carcinoma in young adults: an alarming national trend.

OBJECTIVES: To assess the incidence, treatment methods, and outcomes of oropharyngeal squamous cell carcinoma (OPSCC) in patients younger than 45 years. STUDY DESIGN: Retrospective population based. SETTING: Surveillance Epidemiology End Results (SEER) 9 database. SUBJECTS AND METHODS: The SEER 9 database was queried from 1973 to 2009 for OPSCC patients <45 years of age. RESULTS: There were 1603 patients with OPSCC younger than 45 years. The incidence in patients between 36 and 44 years increased from 0.79 to 1.39 (per 100,000). In the same time period, there was an increase in the rate from 0.20 to 0.42 in whites and a decrease in the rate in African American (AA) patients from 0.67 to 0.32. The proportion of grade III/IV tumors also steadily increased from 28% in 1973 to 1979 to 43% in 2000 to 2009 (P < .0001). Surgery alone was performed in 220 patients (13.72%) and in combination with radiation therapy in 734 patients (45.79%). Five-year survival for the study cohort is 54%. Compared with white patients, AA patients had worse survival (P < .0001). Patients who had surgery, either alone (localized stage patients) or in combination with radiation, had the highest 5-year survival followed by those who had radiation. CONCLUSIONS: There was an increase in OPSCC in the study patients within the past 4 decades, particularly in those aged 36 to 44 years. Interestingly, the incidence in whites increased and in AA patients it decreased. It is important to note that most of these patients were treated with surgery, either alone or with radiation therapy. The rising incidence within recent decades is thought to be related to human papillomavirus transmission and changes in sexual practices.

The impact of tumor grade on survival end points and patterns of recurrence of 949 patients with early-stage endometrioid carcinoma: a single institution study.

OBJECTIVES: This study aimed to determine the impact of tumor grade on patterns of recurrence and survival end points in patients with endometrioid carcinoma 2009 International Federation of Gynecology and Obstetrics stages I-II. METHODS: We identified 949 patients who underwent hysterectomy between 1988 and 2011. Patients were divided into 3 groups based on tumor grade. Kaplan-Meier plots were generated for each group for recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). RESULTS: Median follow-up was 52 months. Median age was 60 years. All patients underwent total abdominal hysterectomy and salpingo-oophorectomy. Eighty percent of patients underwent lymph node dissection, 83% had peritoneal cytology. There were 76 (8%) patients who developed tumor recurrence. Tumor recurrence rates were significantly higher in patients with grade 3 tumors compared to grade 1 (P = 0.006). Additionally, patients with grade 3 tumors developed significantly more frequent distant metastases compared to patients with grade 1 (P = 0.002). Five-year RFS for the patients with grade 1, 2, and 3 were 95%, 82%, and 68%, respectively (P = <0.001). Five-year DSS was 99%, 93%, and 79%, respectively (P = <0.001). Five-year OS was 89%, 84%, and 63%, respectively (P = <0.001). Lymphovascular space involvement and grade were significant independent predictors of RFS and DSS. For OS age, lymphovascular space involvement, grade, and body mass index were significant predictors. CONCLUSIONS: International Federation of Gynecology and Obstetrics grade is a strong predictor of clinical survival end points in women with early-stage endometrioid carcinoma. The pattern of recurrence in patients with grade 3 tumors is mainly distant rather than locoregional. Further studies incorporating systemic therapy in the adjuvant settings in these patients are warranted.

Impact of age-adjusted Charlson comorbidity score on outcomes for patients with early-stage endometrial cancer.

OBJECTIVES: To determine the impact of Age-Adjusted Charlson Comorbidity (AAC) index score on survival outcomes for patients with early stage endometrial cancer. METHODS: After IRB-approval, AAC score at time of hysterectomy was retrospectively tabulated by physician chart review for 671 patients with 2009 FIGO stage I-II endometrioid adenocarcinoma. Patients were grouped based on their AAC scores as follows: 0-1 (n=204), 2-3 (n=293) and >3 (n=174). Kaplan-Meier and log-rank test methods and univariate and multivariate modeling with Cox regression analysis was used to determine significant predictors of each survival endpoint. RESULTS: After a median follow-up of 85 months, 225 deaths were recorded (34 from EC and 191 from other causes) with a 7-year Overall (OS) and Disease-specific survival (DSS) of 77.6% and 94.0%, respectively. Based on AAC grouping, the 7-year OS, DSS, and Recurrence-free survival (RFS) were: 92.9%, 96.8%, and 94.9% for AAC 0-1; 81.7%, 95.3%, and 89.8% for AAC 2-3: and 56%, 88.2%, and 84.9% for AAC>3 (p<0.0001, p=0.005 and p=0.013, respectively). On multivariate analyses, higher AAC score, tumor grade, lower uterine segment involvement, and lymphovascular space invasion were significantly independent predictors for shorter OS, while for DSS and RFS, higher tumor grade and lymphovascular space invasion were significant predictors of worse outcome, but higher AAC score was not. CONCLUSIONS: Comorbidity score is as important as pathological features for predicting overall survival outcomes in patients with early-stage endometrioid endometrial carcinoma. Higher AAC scores accurately predicted for worse OS. Comorbidity score should be considered in prospective clinical trials of endometrial carcinoma.

Hysterectomy for uterine adenocarcinoma in the elderly: tumor characteristics, and long-term outcome.

OBJECTIVES: To evaluate the tumor recurrences and survival in elderly patients ≥75 years of age with uterine endometrioid carcinoma treated with surgical staging with/without adjuvant radiation therapy (RT). METHODS: We identified 675 surgically staged patients with FIGO stage I-II uterine endometrioid carcinoma who were treated between 1985 and 2009. Their medical records were retrospectively reviewed in this IRB-approved study. Patients were classified as ≥75 years vs. <75 years and compared regarding tumor recurrence and survival. Following a univariate analysis, multivariable modeling was done using Cox regression analysis. RESULTS: 121 patients (18%) were ≥75 years old at the time of hysterectomy. For this group of elderly patients, median age was 79. All patients were surgically staged and some received adjuvant RT. Older patients were found to have higher FIGO stages (p<0.001), higher grade tumors (p<0.001), more frequent deep myometrial involvement (p<0.001), and more frequent lower uterine segment involvement (p<0.001). There was no significant difference found between older and younger patients with respect to lymphovascular space involvement (LVSI) (p=0.415), number of lymph nodes dissected (p=0.440), or adjuvant RT received (p=0.089). Older patients had more tumor recurrence (15% vs 7%) (p=0.005) and lower five year relapse-free survival of 80% compared to 90% in younger patients (p=0.0016). Multivariate analysis confirmed the significance of LVSI, grade 3 tumors, and deep myometrial invasion as prognostic factors for recurrence. After adjusting for other poor prognostic factors, age was not found to be an independent prognostic factor for recurrence. CONCLUSION: Despite similar surgical staging and adjuvant radiation treatment, patients ≥75 years old diagnosed with FIGO stage I-II uterine endometrioid carcinoma were found to have more adverse pathologic features and worse relapse-free, disease-specific and overall survival than younger patients. Age ≥75 years alone may not be an independent significant prognostic factor affecting tumor recurrence.