Worse prognosis in females with new onset of depression after oral cancer diagnosis: a retrospective case-control study

Elena Hofmann; Christian Doll; Alize Rogge; Robert Preissner; Max Heiland; Saskia Preissner; Steffen Koerdt

doi:10.3389/fonc.2023.1248926

Worse prognosis in females with new onset of depression after oral cancer diagnosis: a retrospective case-control study

Front Oncol. 2023 Oct 12:13:1248926. doi: 10.3389/fonc.2023.1248926. eCollection 2023.

Authors

Elena Hofmann^{1

2}, Christian Doll¹, Alize Rogge³, Robert Preissner⁴, Max Heiland¹, Saskia Preissner¹, Steffen Koerdt¹

Affiliations

¹ Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
² Berlin Institute of Health (BIH) Charité Junior Clinician Scientist Program, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin Institute of Health Biomedical Innovation Academy, Berlin, Germany.
³ Centre for Patient-Centered Outcomes Research, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
⁴ Institute of Physiology and Science-IT, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.

Abstract

Background: Sex-related discrepancies in the prognosis of oral cancer patients have not been clarified. This study aimed to assess survival outcomes and potential prognostic factors in female and male patients with oral cancer.

Methods: A retrospective search of the TriNetX network (TriNetX, Cambridge, Massachusetts, USA) was conducted to identify patients diagnosed with oral cancer (International Classification of Diseases (ICD)-10 codes C02-C06), within the past 20 years from the access date April 21, 2023. Patients were categorized according to sex (female vs. male). Following matching for age and risk factors such as nicotine dependence and alcohol abuse, Kaplan-Meier analysis was performed and risk, odds, and hazard ratios were calculated. Outcome variables were five-year disease-free survival (DFS) and overall survival (OS). Additionally, the female and male patient cohort were compared with regard to the novel diagnosis of depression (depressive episode, major depressive disorder, dysthymic disorder) after the tumor diagnosis.

Results: A total of 77,348 patients were assessed. After propensity score matching, 26,578 male and 26,578 female patients were included in each group (mean age 63 years). DFS (71.92% in females vs. 68.29% in males; hazard ratio (HR) 0.870; p < 0.001) and OS (77.08% in females vs. 71.74% in males; HR 0.793; p < 0.001) were significantly higher in the female cohort. However, in patients diagnosed with depression after the initial cancer diagnosis (N = 4,824), survival was worse in female patients compared to male patients (82.48% in females vs. 86.10% in males; HR 1.341; p < 0.001).

Conclusion: This retrospective case-control study showed that females with oral cancer had a better DFS and OS than males. However, survival in females with a newly diagnosed depression after the oral cancer diagnosis was worse compared to those of male oral cancer patients. Depression may be a relevant prognostic factor that contributes to sex disparities in oral cancer patients.

Keywords: depression; female; gender aspects; oral cancer; prognostic factors; real-world data; sex.