Predictors of Competing Mortality in Advanced Head and Neck Cancer
Predictors of Competing Mortality in Advanced Head and Neck Cancer
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DOI：
10.1200/jco.2008.20.9288
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发表时间：
2010-01-01
影响因子：
45.3
通讯作者：
Weichselbaum, Ralph R.
中科院分区：
文献类型：
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作者：
Mell, Loren K.;Dignam, James J.;Weichselbaum, Ralph R.
目的非癌症原因导致的死亡（竞争性死亡）是头颈癌的一个重要事件，但缺乏确定该事件预测因素的研究。我们试图确定竞争性死亡率的预测因子，并开发竞争性事件的风险分层模型。 患者和方法 对 1993 年 8 月至 2004 年 11 月期间诊断的 479 名 III 期至 IV 期头颈癌患者进行队列研究。患者接受了涉及器官保留放化疗和手术的连续前瞻性临床试验。我们使用多变量竞争风险回归模型来分析与竞争死亡率、局部和远处失败以及作为首发事件的第二恶性肿瘤的累积发生率相关的因素。结果幸存者的中位随访时间为 52 个月。竞争性死亡率的 5 年累积发生率为 19.6%（95% CI，15.8 至 23.4）。在多变量分析中，竞争性死亡率与女性性别（风险比[HR]，1.72；95% CI，1.13至2.63）、年龄增加（HR，1.30；95% CI，1.04至1.62）、查尔森合并症指数增加（HR，1.24；95% CI，1.05至1.47）、体重指数降低相关（HR，0.33；95% CI，0.13 至 0.84），并且减少前往治疗中心的距离（HR，0.65；95% CI，0.44 至 0.98）。具有零个、一个、两个和≥三个危险因素的患者的 5 年竞争死亡率分别为 8.9%（95% CI，3.0% 至 14.8%）、12.4%（95% CI，7.0% 至 17.8%）、22.1%（95% CI，14.5% 至 29.7%）和 39.3%（95% CI，14.5% 至 29.7%）。分别为 28.6% 至 50.1%。 结论 晚期头颈癌的竞争死亡率与多种人口和健康状况特征相关。对竞争性死亡率的风险因素进行分析可能有助于报告结果和设计临床试验。
PurposeDeath from noncancer causes (competing mortality) is an important event in head and neck cancer, but studies identifying predictors of this event are lacking. We sought to identify predictors of competing mortality and develop a risk stratification model for competing events.Patients and MethodsCohort study of 479 patients with stage III to IV carcinoma of the head and neck diagnosed between August 1993 and November 2004. Patients were treated on consecutive prospective clinical trials involving organ-preserving chemoradiotherapy and surgery. We used multivariable competing risks regression models to analyze factors associated with the cumulative incidence of competing mortality, locoregional and distant failure, and second malignancies as first events.ResultsMedian follow-up was 52 months median for survivors. The 5-year cumulative incidence of competing mortality was 19.6% (95% CI, 15.8 to 23.4). On multivariable analysis, competing mortality was associated with female sex (hazard ratio [HR], 1.72; 95% CI, 1.13 to 2.63), increasing age (HR, 1.30; 95% CI, 1.04 to 1.62), increasing Charlson Comorbidity Index (HR, 1.24; 95% CI, 1.05 to 1.47), decreasing body mass index (HR, 0.33; 95% CI, 0.13 to 0.84), and decreasing distance traveled to the treating center (HR, 0.65; 95% CI, 0.44 to 0.98). Patients with zero, one, two, and >= three risk factors had 5-year competing mortality of 8.9% (95% CI, 3.0% to 14.8%), 12.4% (95% CI, 7.0% to 17.8%), 22.1% (95% CI, 14.5% to 29.7%), and 39.3% (95% CI, 28.6% to 50.1%), respectively.ConclusionCompeting mortality in advanced head and neck cancer is associated with several demographic and health status characteristics. Analyses of risk factors for competing mortality may be useful in outcomes reporting and designing clinical trials.