Predictors for distant metastases in patients with head and neck cancer.

Blaauw, J. (Jurre) (2015) Predictors for distant metastases in patients with head and neck cancer. thesis, Medicine.

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Abstract

Head and neck cancer (HNC) is the sixth most common solid malignancy in the world. Although HNC is considered to be a locoregional disease, in a significant number of patients, survival is highly influenced by the occurrence of distant metastases (DM). Data on risk factors of the presence of DM’s are controversial in the literature; however primary tumor site, T- and N-stage, histology grades and local disease control are considered to be the most important ones. Finding such predictors of DM’s in HNC patients can help clinicians in differentiating between high- and low-risk patients. The present study aimed to determine predictive patient and tumor characteristics, for the development of DM’s, in a cohort of HNC patients who developed DM within 60 months of primary diagnosis. Methods In our cross-sectional study one hundred and five HNC patients were included with in total 116 DM’s. HNC patients with DM were selected from a database acquired from the Dutch Comprehensive Cancer Center, regarding all HNC patients treated in the UMCG between 1999 and 2008, consisting of 2132 patients. Patient and tumor characteristics such as: gender, age, intoxication, height, length, body mass index, comorbidities, TNM-stage, histology, treatment and imaging modalities were extracted from the electronic patient’s dossiers. Descriptive statistics and Kaplan Meier survival analysis were performed. Results Of the 105 patients, there were 82 males (78%) and 23 females (22%). 67% of the included patients were active smokers and 57% were active drinkers. The median age at diagnosis was 61 years and median BMI was 23,2. Fifty-three percent of the population reported with none/mild comorbidity and 42 percent reported with moderate/severe comorbidity, classified according to the ACE-27 index. We found 73% Stage IV tumors, 49% T4 tumors and in 72% of the cases N+ nodal stage. Extracapsular spread, perineural growth and angioinvasion were found in respectively 18, 13 and 11 percent of the surgically treated cases, but were more often unknown (68, 73 and 70 percent of the cases). Post-operative resection margins were positive in 24% of the cases. The preferred location of the DM was the lung with 52%, followed by the bones with 32% and then the liver with 9%. The median metastasis-free survival time was 8 months. We did not find significant differences between the metastasis-free survival times of the different primary tumor sites, or DM sites. (p-values 0.280 and 0.882) Conclusion Male gender, smoking, drinking and BMI seems to play a role in the development of DM. N+, T4 and stage IV tumors were found in high percentage in the cohort of HNC patients with DM. The lungs and bones are the most prominent sites of DM; therefore these organs have to be screened for DM, especially within the first 8 months after diagnosis. This study can be an important first step towards the development of a clinically useable model; however, further and more extensive research is needed for such a model, analyzing a study population, containing HNC patients with and without DM in follow-up.

Item Type:	Thesis (Thesis)
Supervisor name:	Halmos, Dr. G.B. and Bock, Prof. dr. G.H. de
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:51
Last Modified:	25 Jun 2020 10:51
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1222

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