Chemoradiation and local recurrence of head and neck squamous cell carcinoma and the risk of carotid artery blowout.
Aged
Carotid Arteries
/ radiation effects
Carotid Artery Diseases
/ etiology
Chemoradiotherapy
/ adverse effects
Female
Head and Neck Neoplasms
/ therapy
Humans
Male
Middle Aged
Proportional Hazards Models
Rupture, Spontaneous
/ etiology
Squamous Cell Carcinoma of Head and Neck
/ therapy
Survival Analysis
carotid artery blow out
chemoradiation
head and neck squamous cell carcinoma
outcome
risk factor
therapy
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
09 2019
09 2019
Historique:
received:
03
08
2018
revised:
18
04
2019
accepted:
23
04
2019
pubmed:
10
5
2019
medline:
27
11
2020
entrez:
10
5
2019
Statut:
ppublish
Résumé
Carotid blowout syndrome (CBS) is a rare but life-threatening complication of head and neck squamous cell carcinoma (HNSCC). Chemoradiation (CRT) may make CBS more likely, but so far no longitudinal analysis of different treatment strategies has been conducted. In the present study, 1072 patients with HNSCC were divided into groups depending on whether they had experienced CBS. Disease-related data were analyzed using chi-square test, Fisher exact test, and Student's t test. Survival rates were calculated using Kaplan-Meier test, log-rank test, and the Cox regression analysis for forward selection. Thirty-six patients suffering from CBS demonstrated significantly advanced T status (P = .001) and UICC stage (P = .004) when compared with unaltered counterparts. After adjustment for UICC stage, OS was comparable in both groups, whereas the mean recurrence-free survival (RFS) rate was better in unaltered patients (67 vs 24 months; P < .0001). Cox regression for forward selection revealed local recurrence (hazard ratio [HR], 1.9; P < .0001), T status (HR, 1.9; P = .03), and CRT (HR, 2.0; P < .0001) as independent risk factors for mortality related to CBS. CBS is a rare event in patients with HNSCC demonstrating reduced OS/RFS. Advanced T status, C/RT, and the recurrence of local tumors increase the risk of CBS-associated death.
Sections du résumé
BACKGROUND
Carotid blowout syndrome (CBS) is a rare but life-threatening complication of head and neck squamous cell carcinoma (HNSCC). Chemoradiation (CRT) may make CBS more likely, but so far no longitudinal analysis of different treatment strategies has been conducted.
METHODS
In the present study, 1072 patients with HNSCC were divided into groups depending on whether they had experienced CBS. Disease-related data were analyzed using chi-square test, Fisher exact test, and Student's t test. Survival rates were calculated using Kaplan-Meier test, log-rank test, and the Cox regression analysis for forward selection.
RESULTS
Thirty-six patients suffering from CBS demonstrated significantly advanced T status (P = .001) and UICC stage (P = .004) when compared with unaltered counterparts. After adjustment for UICC stage, OS was comparable in both groups, whereas the mean recurrence-free survival (RFS) rate was better in unaltered patients (67 vs 24 months; P < .0001). Cox regression for forward selection revealed local recurrence (hazard ratio [HR], 1.9; P < .0001), T status (HR, 1.9; P = .03), and CRT (HR, 2.0; P < .0001) as independent risk factors for mortality related to CBS.
CONCLUSION
CBS is a rare event in patients with HNSCC demonstrating reduced OS/RFS. Advanced T status, C/RT, and the recurrence of local tumors increase the risk of CBS-associated death.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3073-3079Informations de copyright
© 2019 Wiley Periodicals, Inc.