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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
Rivista di Chirurgia Maxillo-Facciale
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2009 December;20(3):149-55
Do age and comorbidities in elderly patients with oral squamous cell carcinoma affect the therapeutic workflow?
Marchetti C. 1, Pizzigallo A. 1, Badiali G. 1, Bassi M. 2, Campobassi A. 2
1 Department of Oral and Maxillofacial Surgery, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy;
2 Department of Maxillofacial Surgery, Bufalini Hospital, Cesena, Italy
AIM: Chronologic age is still a cause of unjustified substandard treatment for head and neck malignancies, which worsens significantly prognosis. The aim of this study was to analyse the role of age and related comorbidities as prognostic factors in patients affected by oral squamous cell carcinoma (OSCC).
METHODS: We retrospectively studied 165 consecutive patients with OSCC admitted to our Units from September 1998 to January 2009: 23 stage I subjects (13.9%); 33 stage II subjects (20.0%); 41 stage III subjects (24.8%); and 68 stage IV subjects (41.2%). Furthermore, we determined for each patient the grade of systemic illness using the Kaplan-Feinstein Comorbidity Index modified by Piccirillo, which is a widely validated simple tool. To identify the role of age in survival we splitted our study group into two sub-groups: young patients (>70) and elderly patients (<70).
RESULTS: Sixty patients (36.4%) died during the follow up, 41 of which (24.8%) died of disease. Actuarial five-year overall survival were 55.7% (SE=5.0%). Actuarial five-year disease-specific survival were 68.1% (SE=4.8%). Age did not appear to be a prognostic factor neither for overall survival (P=0.279) nor for disease-specific survival (P=0.562). The Comorbidity Index appeared to be a good prognostic factor for overall survival (P=0.002%), but not for disease-specific survival (P=0.578). Multivariate analysis confirmed that comorbidities are reasonably a prognostic factor for overall survival (P=0.014) and that stage is the only prognostic factor that affect tumor-specific survival (P<0.001).
CONCLUSION: In conclusion, age is not a prognostic factor for outcome of OSCC patients, if considered alone. Comorbidities must be always included in evaluation of these patients, because they can affect long-term survival, but not purely treatment outcome.