Mortality patterns of patients with tonsillar squamous cell carcinoma: a population-based study

Jia Wang; Xiaolin Li; Dongdong Niu; Jiasheng Huang; Enlin Ye; Yumei Zhao; Suru Yue; Xuefei Hou; Jiayuan Wu

doi:10.3389/fendo.2023.1158593

Mortality patterns of patients with tonsillar squamous cell carcinoma: a population-based study

Front Endocrinol (Lausanne). 2023 Dec 7:14:1158593. doi: 10.3389/fendo.2023.1158593. eCollection 2023.

Authors

Jia Wang^#^{1

2}, Xiaolin Li^#^{1

2}, Dongdong Niu^#^{1

2}, Jiasheng Huang¹, Enlin Ye¹, Yumei Zhao¹, Suru Yue¹, Xuefei Hou^{1

2}, Jiayuan Wu^{1

2}

Affiliations

¹ Clinical Research Service Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.
² Guangdong Engineering Research Center of Collaborative Innovation of Clinical Medical Big Data Cloud Service in Western Guangdong Medical Union, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China.

^# Contributed equally.

Abstract

Objective: Tonsillar squamous cell carcinoma (TSCC) and second primary malignancies (SPMs) are the most common causes of mortality in patients with primary TSCC. However, the competing data on TSCC-specific death (TSD) or SPM-related death in patients with TSCC have not been evaluated. This study aimed to analyze the mortality patterns and formulate prediction models of mortality risk caused by TSCC and SPMs.

Methods: Data on patients with a first diagnosis of TSCC were extracted as the training cohort from the 18 registries comprising the Surveillance, Epidemiology, and End Results (SEER) database. A competing risk approach of cumulation incidence function was used to estimate cumulative incidence curves. Fine and gray proportional sub-distributed hazard model analyses were performed to investigate the risk factors of TSD and SPMs. A nomogram was developed to predict the 5- and 10-year risk probabilities of death caused by TSCC and SPMs. Moreover, data from the 22 registries of the SEER database were also extracted to validate the nomograms.

Results: In the training cohort, we identified 14,530 patients with primary TSCC, with TSCC (46.84%) as the leading cause of death, followed by SPMs (26.86%) among all causes of death. In the proportion of SPMs, the lungs and bronchus (22.64%) were the most common sites for SPM-related deaths, followed by the larynx (9.99%), esophagus (8.46%), and Non-Melanoma skin (6.82%). Multivariate competing risk model showed that age, ethnicity, marital status, primary site, summary stage, radiotherapy, and surgery were independently associated with mortality caused by TSCC and SPMs. Such risk factors were selected to formulate prognostic nomograms. The nomograms showed preferable discrimination and calibration in both the training and validation cohorts.

Conclusion: Patients with primary TSCC have a high mortality risk of SPMs, and the competing risk nomogram has an ideal performance for predicting TSD and SPMs-related mortality. Routine follow-up care for TSCC survivors should be expanded to monitor SPMs.

Keywords: competitive risk model; nomogram; risk factor; second primary malignancies; tonsillar squamous cell carcinoma.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Squamous Cell* / epidemiology
Carcinoma, Squamous Cell* / pathology
Humans
Neoplasms, Second Primary* / epidemiology
Nomograms
Prognosis
Risk Factors
SEER Program

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Competitive Allocation Project of Zhanjiang Science and Technology Development Special Fund (2022A01161), and the Affiliated Hospital of Guangdong Medical University Clinical Research Project (LCYJ2019B005).