Analysis Of Risk Factors And Prognosis Of Patients With Head And Neck Squamous Cell Carcinoma And Lung Metastasis Based On The SEER Database

Purpose:The purpose of this study is to analyze the clinicopathological features and prognosis of patients with head and neck squamous cell carcinoma and patients with lung metastasis through SEER database,and to explore the related risk factors of head and neck squamous cell carcinoma and lung metastasis,so as to provide reference for the diagnosis and treatment of patients with head and neck squamous cell carcinoma and lung metastasis.Methods:Collect the clinical data of patients diagnosed with head and neck squamous cell carcinoma from 2010 to 2015 in the SEER database,including age,gender,race,primary tumor site,histological grade,affected side,tumor stage,regional lymph node surgery,radiotherapy,chemotherapy,Variables such as distant metastasis and cause of death.The Kaplan-Meier method was used to calculate the survival rate,the Log-rank test was used for univariate analysis,and the survival curve was drawn,and the Cox regression model was used for multivariate analysis of prognosticrelated risk factors.Results:Among the 34,095 head and neck squamous cell carcinoma patients included in this study,26094 were male patients(76.5%)and 8001 were female patients(23.5%),with a median age of 62 years and a median survival time of 27 months.Univariate analysis showed: gender(P<0.001),age(P<0.001),location of disease(P<0.001),local lymph node surgery method(P<0.001),radiotherapy(P<0.001),chemotherapy(P<0.001),T stage(P<0.001),affected side(P<0.001),degree of tumor differentiation(P<0.001)and race(P<0.001)are related factors affecting the prognosis of patients.Multivariate analysis showed that in terms of gender,female patients had VS and male patients(HR=1.117,95%CI:1.072-1.164,P <0.001).In terms of age,patients ≥ 60 years old and VS < 60 years old(HR=1.592,95%CI:1562-1.685 P < 0.001).The location of the disease was oropharyngeal VS oral cavity(HR=0.915,95%CI:0.864-0.970,0.003),hypopharyngeal VS oral cavity(HR=1.793,95%CI:1.670-1.924,P < 0.001),nasopharyngeal VS oral cavity(HR=1.242,95%CI:1.108-1.392,P < 0.001),laryngeal VS oral cavity(HR=1.067,95%CI:1.020-1.117).In terms of local lymph node surgery,patients who underwent biopsy or lymph node aspiration underwent VS to remove 1-3 regional lymph nodes(HR=1.478,95%CI:1.288-1.696,P < 0.001).In the aspect of radiotherapy,the patients who did not receive radiotherapy or completed radiotherapy with unknown VS(HR=1.926,95%CI:1.839-2.017,P < 0.001).In terms of chemotherapy,patients without chemotherapy completed chemotherapy with VS(HR=1.127,95%CI:1.075-1.181,P < 0.001).T staging was compared with T1,T2(HR=2.421 95%CI:2.278-2.573,P < 0.001),T3(HR=4.06695%CI:3.814-4.335,P < 0.001),T4(HR=6.186 95%CI:5.821-6.574,P < 0.001),TX(HR=2.300 95%CI:2.151-2.459,P < 0.001).In terms of ipsilateral side,the patients with unilateral or non-paired VS deviated to the left side(HR=1.18695%CI:1.125-1.250,P < 0.001).In the degree of differentiation,II grade moderately differentiation VSI grade(HR=1.50995%CI:1.412-1.612)(HR=1.509 95%CI:1.412-1.612),Ⅲ grade poorly differentiation VSI grade(HR=1.528 95%CI:1.423-1.640)(P < 0.001),IV grade undifferentiated VSI grade(HR=1.53695%CI:1.205-1.958)(high differentiation),unknown grade VSI(high differentiation)(HR=1.47095%CI:1.370-1.577).P < 0.001).In terms of race,white race with VS black race(HR=0.704 95%CI:0.669-0.741,P < 0.001),other ethnic VS black race(HR=0.574 95%CI:0.525-0.627,P < 0.001).To sum up,gender,age,location,local lymph node operation,radiotherapy,chemotherapy,T stage,ipsilateral side,degree of differentiation and race were independent factors affecting the prognosis and survival of patients with head and neck squamous cell carcinoma(P < 0.05).A total of 1265 patients with distant metastasis were included in this study,accounting for 37.1% of the total,and 691 patients with newly diagnosed lung metastasis,accounting for 54.6% of the total number of distant(organ)metastases.The 1-and 3-year tumor-specific survival rates of patients with lung metastasis were 91.58% and 49.68% respectively,the median survival time was 7 months,and the average survival time was10.96 months.Univariate analysis showed that T stage(P < 0.001),local lymph node operation(P < 0.031),radiotherapy(P < 0.05),chemotherapy(P < 0.001),bone metastasis(P < 0.006),brain metastasis(P < 0.005)and liver metastasis(P < 0.003)were related factors affecting the prognosis of patients with lung metastasis of head and neck squamous cell carcinoma.Multivariate analysis showed that patients who did not receive radiotherapy or unknown VS completed radiotherapy(HR=1.462,95%CI:1.237-1.729,P< 0.001),patients who did not receive chemotherapy,VS completed chemotherapy(HR=2.169,95%CI:1.827-2.576,P < 0.001).The patients with bone metastasis had VS without bone metastasis(HR=1.291,95%CI:1.040-1.602),the patients with brain metastasis had VS without brain metastasis(HR=1.698,95%CI:1.051-2.74),and the patients with liver metastasis had VS without liver metastasis(HR=1.372,95%CI:1.047-1.798).In summary,radiotherapy,chemotherapy,combined with bone metastasis,brain metastasis and liver metastasis were independent factors affecting the prognosis and survival of patients with lung metastasis of head and neck squamous cell carcinoma.Conclusion:1.Gender,age,location,local lymph node operation,radiotherapy,chemotherapy,T stage,affected side,tumor differentiation and race are the related factors and independent risk factors affecting the prognosis and survival of head and neck squamous cell carcinoma.2.T stage,local lymph node operation,radiotherapy,chemotherapy,bone metastasis,brain metastasis and liver metastasis are the related factors affecting the prognosis of patients with lung metastasis of head and neck squamous cell carcinoma.Radiotherapy,chemotherapy,bone metastasis,brain metastasis and liver metastasis were independent risk factors affecting the prognosis and survival of patients with lung metastasis of head and neck squamous cell carcinoma.