Association Between Age And Prognosis Of Head And Neck Squamous Cell Carcinoma:A SEER Population-based Study

Objective:Whether age is a prognostic parameter of head and neck squamous cell carcinoma(HNSCC)remains controversial.The purpose of this study is to analyze the influence of age on overall survival and the relationship of age with TNM stage and histological grade in HNSCC.Materials and Methods:Patients with head and neck squamous cell carcinoma(HNSCC)diagnosed between 2004-2014 were identified from the surveillance,epidemiology and End Results(SEER)database.The association of age with TNM stage and histological grade was analyzed by univariate and multivariate ordinal logistic regression analysis.Kaplan-Meier methods were used to calculate the OS for each age group and subgroup.Univariate and multivariate Cox proportional hazards models were used to analyze whether age was an independent prognostic factor for HNSCC.Results:We identified 83737 patients.Age was analyzed in 5-,10-,15-,and 20-year intervals,each of which gave similar results.The 15-year intervals data were selected for presentation(<30,30–45,45–60,60-75,75-90,90+ years).1.The relationship of age with TNM stage and histological grade was similar.For patients aged younger than 45 years old,the proportion of stage ? and grade ?/? gradually increased with age and reached its peak at 45-60 years old,but an inverse correlation of age with stage and grade after age 60 was found.2.The results of univariate and multivariate logistic regression analysis showed that compared with 45-60 age group,the 30-45 age group had a lower risk of being diagnosed with advanced stage(OR=0.82,95%CI: 0.77-0.87,P<0.001),as well as <30 age group(OR=0.41,95%CI: 0.34-0.50,P<0.001).Surprisingly patients older than 60 years(60-75,75-90,>90)also had a lower risk of being diagnosed with advanced stage,the OR values were 0.67,0.45 and 0.40 respectively(P<0.001).Therefore,the 45-60 age group had the highest risk of being diagnosed with advanced stage and grade.3.Kaplan-Meier survival curves showed that the overall survival time of HNSCC patients decreased with increasing of age(all P < 0.001).Not reached,118,71,32,11 months,in patients aged 45 years or younger,45-60,60-75,75-90,>90 respectively.4.Subgroup analysis by grade and stage showed that OS was consistent in HNSCC.5.Univariate and multivariate Cox proportional hazards model analysis showed that age was an independent prognostic risk factor for HNSCC.The HR value increased with age.Patients younger than 45 years old obviously had lower risk of death than the age group 45-60.The risk of death in the 60-75 age group was 1.37 times as high as that in the 45-60 age group(HR=1.37,95%CI: 1.33-1.40,P<0.001).The risk of death in the age group 75-90 was 2.44 times higher than that in the age group of 45-60(HR=2.44,95%CI: 2.36-2.52,P<0.001),and the age group of >90 had the highest risk of death and worst survival(HR=4.80,95%CI: 4.40-5.24,P<0.001).Conclusion:1.Increasing age is associated with advanced stage and grade.Patients aged 45-60 years have the highest risk of developing advanced stage and grade.2.Age is an independent prognostic risk factor for HNSCC,and increasing age is associated with worsening OS.This finding has guiding significance for patients' clinical decision-making and prognosis education.