Perioperative survival of elderly head and neck squamous cell carcinoma patients

Abstract

Objectives/hypothesis: To evaluate the survival benefit of surgery for elderly head and neck cancer (HNC) patients.

Study design: Retrospective national database cohort study of HNC patients.

Methods: The study is a retrospective cohort review of the Surveillance, Epidemiology, and End-Results (SEER) database from 2004 to 2009. We developed an estimated perioperative window, based on the institutional database at a tertiary academic center. The average time to surgery among HNC patients at this center correlated with SEER's 3-month post diagnosis. From this estimate, we calculated postoperative (3 months), 2-year, and 5-year overall survival (OS) for patients receiving HNC surgery from 2004 to 2009 in the SEER database. Patients were matched for sex, tumor grade/stage, primary location, and radiation treatment status.

Results: Overall, after matching we found a statistically significant decrease in 3-month OS for the elderly patients versus younger controls who received surgery (P < .05). However, a matched analysis of elderly patients alone found a significant increase in OS for elderly patients who received surgery compared to those who did not (P < .05).

Conclusions: Surgery appears to offer overall benefit to elderly HNC patients. These patients have a significantly worse postoperative OS than their younger counterparts, but the clinical significance appears to be limited. The improved survival among elderly patients who receive surgery compared to those who do not suggests that surgery should be offered to properly selected patients regardless of age.

Keywords: Aged; elderly; head and neck neoplasms; larynx; oral cavity; oropharynx; perioperative survival; squamous cell carcinoma.