Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: A mechanism for increased mortality
BACKGROUND Time to treatment initiation (TTI) is increasing and is associated with worsening survival. In the current study, the authors sought to identify a mechanism for this relationship by assessing the effect of TTI on clinical‐to‐pathologic upstaging in patients with head and neck squamous cel...
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| Veröffentlicht in: | Cancer 2018-04, Vol.124 (7), p.1400-1414 |
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| creator | Xiao, Roy Ward, Matthew C. Yang, Kailin Adelstein, David J. Koyfman, Shlomo A. Prendes, Brandon L. Burkey, Brian B. |
| description | BACKGROUND
Time to treatment initiation (TTI) is increasing and is associated with worsening survival. In the current study, the authors sought to identify a mechanism for this relationship by assessing the effect of TTI on clinical‐to‐pathologic upstaging in patients with head and neck squamous cell carcinoma (HNSCC).
METHODS
Using the National Cancer Data Base, the authors analyzed patients receiving definitive surgery for SCC of the oral cavity, oropharynx, larynx, and hypopharynx from 2005 through 2014. The primary outcome was T, N, or stage group upstaging, defined as higher pathologic stage than clinical stage. TTI was defined as the time between diagnosis and surgery. Multivariable logistic and Cox proportional hazards regression modeled upstaging and survival, respectively.
RESULTS
Cohorts of 60,194 patients, 51,380 patients, and 52,980 patients, respectively, with complete T, N, and stage group data were included. N upstaging was most common (18.6%), followed by stage group (17.4%) and T (12.1%) upstaging; all types were predicted by TTI. Compared with a TTI of 1 to 6 days, TTIs as short as 7 to 13 days (odds ratio, 1.20; P = .038) or ≥ 70 days (odds ratio, 2.04; P |
| doi_str_mv | 10.1002/cncr.31213 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1989555621</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1989555621</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3933-892485606d24c1cec5ec7af6209dec6488680e8e73d29785b40a0d8990b96d603</originalsourceid><addsrcrecordid>eNp90c1qVDEYBuAgih1HN16ABNwU4dT8nOQk7srgT6EoiIK7kEm-mUk9JxmTHMpcgPdtplO7cOEqCTzfm5AXoZeUXFBC2FsXXb7glFH-CC0o0UNHaM8eowUhRHWi5z_O0LNSbtpxYII_RWdMcyp6rRfo91UbBlvA472tuzSmbXB43pdqtyFu8W2oO5xDOe5rmADXhGsbqBPEikMMNdgaUsSblPEOrMc2ehzB_cTORgf5Hb7EE7idjaFMdyo83DilXO0Y6uE5erKxY4EX9-sSff_w_tvqU3f95ePV6vK6c1xz3inNeiUkkZ71jjpwAtxgN5IR7cHJXimpCCgYuGd6UGLdE0u80pqstfSS8CU6P-Xuc_o1Q6lmCsXBONoIaS6GaqWFELJ95RK9_ofepDnH9jrDCB3k0JRu6s1JuZxKybAx-xwmmw-GEnMsxxzLMXflNPzqPnJeT-Af6N82GqAncBtGOPwnyqw-r76eQv8AQnOaig</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2017675629</pqid></control><display><type>article</type><title>Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: A mechanism for increased mortality</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Wiley Online Library Free Content</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Xiao, Roy ; Ward, Matthew C. ; Yang, Kailin ; Adelstein, David J. ; Koyfman, Shlomo A. ; Prendes, Brandon L. ; Burkey, Brian B.</creator><creatorcontrib>Xiao, Roy ; Ward, Matthew C. ; Yang, Kailin ; Adelstein, David J. ; Koyfman, Shlomo A. ; Prendes, Brandon L. ; Burkey, Brian B.</creatorcontrib><description>BACKGROUND
Time to treatment initiation (TTI) is increasing and is associated with worsening survival. In the current study, the authors sought to identify a mechanism for this relationship by assessing the effect of TTI on clinical‐to‐pathologic upstaging in patients with head and neck squamous cell carcinoma (HNSCC).
METHODS
Using the National Cancer Data Base, the authors analyzed patients receiving definitive surgery for SCC of the oral cavity, oropharynx, larynx, and hypopharynx from 2005 through 2014. The primary outcome was T, N, or stage group upstaging, defined as higher pathologic stage than clinical stage. TTI was defined as the time between diagnosis and surgery. Multivariable logistic and Cox proportional hazards regression modeled upstaging and survival, respectively.
RESULTS
Cohorts of 60,194 patients, 51,380 patients, and 52,980 patients, respectively, with complete T, N, and stage group data were included. N upstaging was most common (18.6%), followed by stage group (17.4%) and T (12.1%) upstaging; all types were predicted by TTI. Compared with a TTI of 1 to 6 days, TTIs as short as 7 to 13 days (odds ratio, 1.20; P = .038) or ≥ 70 days (odds ratio, 2.04; P < .001) were found to predict T upstaging, a finding that is consistent for N and stage group upstaging. Using restricted cubic splines, relative odds of T and stage group upstaging escalated to 2.25 and 1.93, respectively, at a TTI of 365 days. In survival analyses, T (hazard ratio [HR], 1.53), N (HR, 1.88), and stage group (HR, 1.69) upstaging all predicted mortality (P < .001), whereas TTI only predicted mortality after 70 days (HR, 1.11; P = .023).
CONCLUSIONS
Tumor progression, measured by clinical‐to‐pathologic upstaging, increases mortality for patients with HNSCC experiencing treatment delays. Cancer 2018;124:1400‐14. © 2018 American Cancer Society.
Tumor progression contributes to increased mortality for patients with head and neck squamous cell carcinoma who are experiencing delays in treatment initiation. This modifiable factor can be used as a health care quality metric.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.31213</identifier><identifier>PMID: 29315499</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Cancer ; Carcinoma, Squamous Cell - mortality ; Carcinoma, Squamous Cell - pathology ; Carcinoma, Squamous Cell - therapy ; Cohort Studies ; Data processing ; Databases, Factual ; Female ; Follow-Up Studies ; Hazards ; Head & neck cancer ; Head and Neck Neoplasms - mortality ; Head and Neck Neoplasms - pathology ; Head and Neck Neoplasms - therapy ; head and neck squamous cell carcinoma ; Humans ; Hypopharynx ; Larynx ; Male ; Middle Aged ; Mortality ; National Cancer Data Base ; Neoplasm Staging ; Oncology ; Oral cavity ; Oropharynx ; overall survival ; Patients ; Pregnancy ; Regression analysis ; Risk Factors ; Splines ; Squamous cell carcinoma ; Surgery ; Survival ; Survival Rate ; time to treatment initiation ; Time-to-Treatment - statistics & numerical data ; Time-to-Treatment - trends ; upstaging</subject><ispartof>Cancer, 2018-04, Vol.124 (7), p.1400-1414</ispartof><rights>2018 American Cancer Society</rights><rights>2018 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3933-892485606d24c1cec5ec7af6209dec6488680e8e73d29785b40a0d8990b96d603</citedby><cites>FETCH-LOGICAL-c3933-892485606d24c1cec5ec7af6209dec6488680e8e73d29785b40a0d8990b96d603</cites><orcidid>0000-0003-4459-0746 ; 0000-0002-8423-890X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.31213$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.31213$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29315499$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Xiao, Roy</creatorcontrib><creatorcontrib>Ward, Matthew C.</creatorcontrib><creatorcontrib>Yang, Kailin</creatorcontrib><creatorcontrib>Adelstein, David J.</creatorcontrib><creatorcontrib>Koyfman, Shlomo A.</creatorcontrib><creatorcontrib>Prendes, Brandon L.</creatorcontrib><creatorcontrib>Burkey, Brian B.</creatorcontrib><title>Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: A mechanism for increased mortality</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND
Time to treatment initiation (TTI) is increasing and is associated with worsening survival. In the current study, the authors sought to identify a mechanism for this relationship by assessing the effect of TTI on clinical‐to‐pathologic upstaging in patients with head and neck squamous cell carcinoma (HNSCC).
METHODS
Using the National Cancer Data Base, the authors analyzed patients receiving definitive surgery for SCC of the oral cavity, oropharynx, larynx, and hypopharynx from 2005 through 2014. The primary outcome was T, N, or stage group upstaging, defined as higher pathologic stage than clinical stage. TTI was defined as the time between diagnosis and surgery. Multivariable logistic and Cox proportional hazards regression modeled upstaging and survival, respectively.
RESULTS
Cohorts of 60,194 patients, 51,380 patients, and 52,980 patients, respectively, with complete T, N, and stage group data were included. N upstaging was most common (18.6%), followed by stage group (17.4%) and T (12.1%) upstaging; all types were predicted by TTI. Compared with a TTI of 1 to 6 days, TTIs as short as 7 to 13 days (odds ratio, 1.20; P = .038) or ≥ 70 days (odds ratio, 2.04; P < .001) were found to predict T upstaging, a finding that is consistent for N and stage group upstaging. Using restricted cubic splines, relative odds of T and stage group upstaging escalated to 2.25 and 1.93, respectively, at a TTI of 365 days. In survival analyses, T (hazard ratio [HR], 1.53), N (HR, 1.88), and stage group (HR, 1.69) upstaging all predicted mortality (P < .001), whereas TTI only predicted mortality after 70 days (HR, 1.11; P = .023).
CONCLUSIONS
Tumor progression, measured by clinical‐to‐pathologic upstaging, increases mortality for patients with HNSCC experiencing treatment delays. Cancer 2018;124:1400‐14. © 2018 American Cancer Society.
Tumor progression contributes to increased mortality for patients with head and neck squamous cell carcinoma who are experiencing delays in treatment initiation. This modifiable factor can be used as a health care quality metric.</description><subject>Cancer</subject><subject>Carcinoma, Squamous Cell - mortality</subject><subject>Carcinoma, Squamous Cell - pathology</subject><subject>Carcinoma, Squamous Cell - therapy</subject><subject>Cohort Studies</subject><subject>Data processing</subject><subject>Databases, Factual</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Hazards</subject><subject>Head & neck cancer</subject><subject>Head and Neck Neoplasms - mortality</subject><subject>Head and Neck Neoplasms - pathology</subject><subject>Head and Neck Neoplasms - therapy</subject><subject>head and neck squamous cell carcinoma</subject><subject>Humans</subject><subject>Hypopharynx</subject><subject>Larynx</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>National Cancer Data Base</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Oral cavity</subject><subject>Oropharynx</subject><subject>overall survival</subject><subject>Patients</subject><subject>Pregnancy</subject><subject>Regression analysis</subject><subject>Risk Factors</subject><subject>Splines</subject><subject>Squamous cell carcinoma</subject><subject>Surgery</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>time to treatment initiation</subject><subject>Time-to-Treatment - statistics & numerical data</subject><subject>Time-to-Treatment - trends</subject><subject>upstaging</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90c1qVDEYBuAgih1HN16ABNwU4dT8nOQk7srgT6EoiIK7kEm-mUk9JxmTHMpcgPdtplO7cOEqCTzfm5AXoZeUXFBC2FsXXb7glFH-CC0o0UNHaM8eowUhRHWi5z_O0LNSbtpxYII_RWdMcyp6rRfo91UbBlvA472tuzSmbXB43pdqtyFu8W2oO5xDOe5rmADXhGsbqBPEikMMNdgaUsSblPEOrMc2ehzB_cTORgf5Hb7EE7idjaFMdyo83DilXO0Y6uE5erKxY4EX9-sSff_w_tvqU3f95ePV6vK6c1xz3inNeiUkkZ71jjpwAtxgN5IR7cHJXimpCCgYuGd6UGLdE0u80pqstfSS8CU6P-Xuc_o1Q6lmCsXBONoIaS6GaqWFELJ95RK9_ofepDnH9jrDCB3k0JRu6s1JuZxKybAx-xwmmw-GEnMsxxzLMXflNPzqPnJeT-Af6N82GqAncBtGOPwnyqw-r76eQv8AQnOaig</recordid><startdate>20180401</startdate><enddate>20180401</enddate><creator>Xiao, Roy</creator><creator>Ward, Matthew C.</creator><creator>Yang, Kailin</creator><creator>Adelstein, David J.</creator><creator>Koyfman, Shlomo A.</creator><creator>Prendes, Brandon L.</creator><creator>Burkey, Brian B.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4459-0746</orcidid><orcidid>https://orcid.org/0000-0002-8423-890X</orcidid></search><sort><creationdate>20180401</creationdate><title>Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: A mechanism for increased mortality</title><author>Xiao, Roy ; Ward, Matthew C. ; Yang, Kailin ; Adelstein, David J. ; Koyfman, Shlomo A. ; Prendes, Brandon L. ; Burkey, Brian B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3933-892485606d24c1cec5ec7af6209dec6488680e8e73d29785b40a0d8990b96d603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Cancer</topic><topic>Carcinoma, Squamous Cell - mortality</topic><topic>Carcinoma, Squamous Cell - pathology</topic><topic>Carcinoma, Squamous Cell - therapy</topic><topic>Cohort Studies</topic><topic>Data processing</topic><topic>Databases, Factual</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Hazards</topic><topic>Head & neck cancer</topic><topic>Head and Neck Neoplasms - mortality</topic><topic>Head and Neck Neoplasms - pathology</topic><topic>Head and Neck Neoplasms - therapy</topic><topic>head and neck squamous cell carcinoma</topic><topic>Humans</topic><topic>Hypopharynx</topic><topic>Larynx</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>National Cancer Data Base</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Oral cavity</topic><topic>Oropharynx</topic><topic>overall survival</topic><topic>Patients</topic><topic>Pregnancy</topic><topic>Regression analysis</topic><topic>Risk Factors</topic><topic>Splines</topic><topic>Squamous cell carcinoma</topic><topic>Surgery</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>time to treatment initiation</topic><topic>Time-to-Treatment - statistics & numerical data</topic><topic>Time-to-Treatment - trends</topic><topic>upstaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Xiao, Roy</creatorcontrib><creatorcontrib>Ward, Matthew C.</creatorcontrib><creatorcontrib>Yang, Kailin</creatorcontrib><creatorcontrib>Adelstein, David J.</creatorcontrib><creatorcontrib>Koyfman, Shlomo A.</creatorcontrib><creatorcontrib>Prendes, Brandon L.</creatorcontrib><creatorcontrib>Burkey, Brian B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Xiao, Roy</au><au>Ward, Matthew C.</au><au>Yang, Kailin</au><au>Adelstein, David J.</au><au>Koyfman, Shlomo A.</au><au>Prendes, Brandon L.</au><au>Burkey, Brian B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: A mechanism for increased mortality</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2018-04-01</date><risdate>2018</risdate><volume>124</volume><issue>7</issue><spage>1400</spage><epage>1414</epage><pages>1400-1414</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>BACKGROUND
Time to treatment initiation (TTI) is increasing and is associated with worsening survival. In the current study, the authors sought to identify a mechanism for this relationship by assessing the effect of TTI on clinical‐to‐pathologic upstaging in patients with head and neck squamous cell carcinoma (HNSCC).
METHODS
Using the National Cancer Data Base, the authors analyzed patients receiving definitive surgery for SCC of the oral cavity, oropharynx, larynx, and hypopharynx from 2005 through 2014. The primary outcome was T, N, or stage group upstaging, defined as higher pathologic stage than clinical stage. TTI was defined as the time between diagnosis and surgery. Multivariable logistic and Cox proportional hazards regression modeled upstaging and survival, respectively.
RESULTS
Cohorts of 60,194 patients, 51,380 patients, and 52,980 patients, respectively, with complete T, N, and stage group data were included. N upstaging was most common (18.6%), followed by stage group (17.4%) and T (12.1%) upstaging; all types were predicted by TTI. Compared with a TTI of 1 to 6 days, TTIs as short as 7 to 13 days (odds ratio, 1.20; P = .038) or ≥ 70 days (odds ratio, 2.04; P < .001) were found to predict T upstaging, a finding that is consistent for N and stage group upstaging. Using restricted cubic splines, relative odds of T and stage group upstaging escalated to 2.25 and 1.93, respectively, at a TTI of 365 days. In survival analyses, T (hazard ratio [HR], 1.53), N (HR, 1.88), and stage group (HR, 1.69) upstaging all predicted mortality (P < .001), whereas TTI only predicted mortality after 70 days (HR, 1.11; P = .023).
CONCLUSIONS
Tumor progression, measured by clinical‐to‐pathologic upstaging, increases mortality for patients with HNSCC experiencing treatment delays. Cancer 2018;124:1400‐14. © 2018 American Cancer Society.
Tumor progression contributes to increased mortality for patients with head and neck squamous cell carcinoma who are experiencing delays in treatment initiation. This modifiable factor can be used as a health care quality metric.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29315499</pmid><doi>10.1002/cncr.31213</doi><tpages>15</tpages><orcidid>https://orcid.org/0000-0003-4459-0746</orcidid><orcidid>https://orcid.org/0000-0002-8423-890X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Wiley Online Library Free Content; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Cancer Carcinoma, Squamous Cell - mortality Carcinoma, Squamous Cell - pathology Carcinoma, Squamous Cell - therapy Cohort Studies Data processing Databases, Factual Female Follow-Up Studies Hazards Head & neck cancer Head and Neck Neoplasms - mortality Head and Neck Neoplasms - pathology Head and Neck Neoplasms - therapy head and neck squamous cell carcinoma Humans Hypopharynx Larynx Male Middle Aged Mortality National Cancer Data Base Neoplasm Staging Oncology Oral cavity Oropharynx overall survival Patients Pregnancy Regression analysis Risk Factors Splines Squamous cell carcinoma Surgery Survival Survival Rate time to treatment initiation Time-to-Treatment - statistics & numerical data Time-to-Treatment - trends upstaging |
| title | Increased pathologic upstaging with rising time to treatment initiation for head and neck cancer: A mechanism for increased mortality |
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