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Original Investigation
December 2015

Selection of Ideal Candidates for Surgical Salvage of Head and Neck Squamous Cell Carcinoma: Effect of the Charlson–Age Comorbidity Index and Oncologic Characteristics on 1-Year Survival and Hospital Course

Author Affiliations
  • 1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 2Department of Otolaryngology–Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 3Biostatistics Facility, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
  • 4Department of Surgery, Division of Otolaryngology–Head and Neck Surgery, Albany Medical College, Albany, New York
JAMA Otolaryngol Head Neck Surg. 2015;141(12):1059-1065. doi:10.1001/jamaoto.2015.2158
Abstract

Importance  Salvage surgery for recurrent head and neck squamous cell carcinoma (HNSCC) carries substantial risks of morbidity and mortality. Risk factors for death within 1 year should be better defined.

Objectives  To report preoperative oncologic prognostic factors predictive of short-term (<1 year) survival after salvage surgery in patients with HNSCC, to assess whether preoperative age and comorbidity predicts 1-year mortality, and to report hospital courses after salvage surgery within 1 year.

Design, Setting, and Participants  A retrospective medical record review of 191 patients with recurrent HNSCC treated with salvage surgery from January 1, 2003, through December 31, 2013, at a tertiary academic center.

Interventions  Surgical salvage of HNSCC (larynx, oral cavity, oropharynx, or hypopharynx) with curative intent.

Main Outcomes and Measures  Primary outcome was survival 1 year after salvage surgery. Secondary outcomes were length of inpatient hospital stay, days of admissions, and skilled nursing facility disposition within 1 year stratified by survival status. Presalvage Charlson–Age Comorbidity Index (CACI) was calculated. Associations among CACI, oncologic risk factors, and risk of death within 1 year after salvage surgery are investigated using multivariable analysis.

Results  Of 191 patients studied, 53 (27.7%) died within 1 year after salvage surgery. Patients who died within 1 year had more total inpatient admissions (P < .001), longer total length of stay (P < .001), and higher risk of discharge to a skilled nursing facility (P < .001) and spent 17.3% (interquartile range, 5.2-36.3) of their remaining days in the hospital. Independent risk factors for death within 1 year are CACI (relative risk [RR], 1.43; 95% CI, 1.16-1.76), primary T3 or T4 stage (RR, 2.34; 95% CI, 1.27-4.31), and disease-free interval of less than 6 months (RR, 5.61; 95% CI, 1.78-16.7).

Conclusions and Relevance  Medical comorbidity and age as measured by the CACI, primary T3 or T4 stage, and short disease-free interval must be considered in selecting patients ideal for surgical salvage surgery for recurrent HNSCC. Patients with these risk factors should be more strongly considered for palliative measures.

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