The effect of young age on outcomes in head and neck cancer

Many head and neck surgeons believe that young patients with head and neck cancer (HNCA) have poorer outcomes than older patients, whereas the evidence in the literature is mixed. We sought to review our HNCA population to evaluate for survival differences between young and older patients.

Matched pair retrospective cohort study.

A matched pair retrospective cohort study was completed of mucosal HNCA patients at our academic center (2003-2008). Patients aged 45 or less when diagnosed were identified as cases and matched one-to-one to controls by site of tumor, stage of disease, and gender. Risk factors, disease and treatment variables, and survival outcomes were compared between groups. In addition, a subset survival analysis was completed with oropharyngeal cancer patients and nonoropharyngeal cancer patients.

There were 87 cases matched to 87 controls. Despite no difference in T and N stage between groups, cases more frequently underwent neck dissection. On Kaplan-Meier and multivariate analysis, overall survival was marginally better for all young patients, whereas disease-free survival was significantly better. Within the subgroup analysis, the statistically significant disease-free survival advantage was lost for young patients with oropharyngeal cancer but maintained for all other sites.

In this cohort, young HNCA patients had mildly improved overall survival but statistically greater disease-free survival. There was no statistically significant survival difference between young and older patients with oropharyngeal cancer, potentially secondary to a human papillomavirus effect.