Scoring System Predicts 90-Day Mortality of Patients With Locally Advanced HNSCC

A scoring system has accurately predicted the 90-day mortality of >16,000 patients with locally advanced head and neck squamous cell carcinoma (HNSCC) who completed concurrent chemoradiotherapy (CCRT; JAMA Netw Open. 2020;3[3]:e1920671).

“There is currently no system to predict 90-day morality among patients with locally advanced [HNSCC] after the completion of [CCRT],” explained Kuan-Chou Lin, DDS, Department of Oral and Maxillofacial Surgery, Wan Fang Hospital, Taipei Medical University, Taiwan, and co-investigators, who sought to validate the accuracy of a predictive scoring system for just this purpose.

Using the Taiwan Cancer Registry Database, Dr Lin et al conducted a prognostic study of 16,029 patients with HNSCC who completed CCRT between January 2006 and December 2015. They also developed a risk scoring system based on significant risk factors and related risk coefficients with the goal of determining 90-day mortality rates for patients who completed CCRT.

The accuracy of the scoring system was analyzed between June 2018 and February 2019.

Ultimately, 1068 (6.66%; mean age, 55.11 years) died before reaching the 90-day threshold, leaving 14,961 (93.4%; mean age, 52.07 years) survivors.

According to multivariable analysis, significant risk factors for 90-day mortality included being aged ≥50 years (adjusted hazard ratio [aHR], 1.263; 95% CI, 1.104-1.445; P <.001), being aged ≥70 years (aHR, 2.183; 95% CI, 1.801-2.645; P <.001), having pneumonia (aHR, 1.946; 95% CI, 1.636-2.314; P <.001), having sepsis (aHR, 3.005; 95% CI, 2.503-3.607; P <.001), having hemiplegia (aHR, 1.430; 95% CI, 1.085-1.884; P = .01), having moderate or severe renal disease (aHR, 2.054; 95% CI, 1.643-2.568; P <.001), having leukemia (aHR, 4.541; 95% CI, 1.132-8.207; P = .03), and having non-HNSCC metastatic solid cancers (aHR, 1.457; 95% CI, 1.292-1.644; P <.001).

Specifically, very low (score of 0), low (score 1-3), moderate (score 4-6), and high (score ≥7) risk scores yielded 90-day mortality rates of 3.37%, 5.00% to 10.98%, 16.15% to 29.13%, and 33.93% to 37.50%, respectively.

In addition, patients with the same risk scores in training and test data sets had similar mortality rates (score of 0, 3.27% vs 3.66%; score of 6, 27.42% vs 25.00%).

“In this prognostic study, a 90-day mortality scoring system accurately predicted 90-day mortality among patients with locally advanced HNSCC who completed CCRT,” Dr Lin and colleagues concluded.—Hina M. Porcelli