Site-Specific Trends in Tumor Distribution, Treatment Patterns, and Survival in Head and Neck Cancer: A SEER Database...

Head and neck cancer (HNC) management has evolved significantly with the introduction of organ-preservation protocols and changing disease etiology.

To analyze site-specific trends in tumor distribution, staging, treatment modality, and survival outcomes using the Surveillance, Epidemiology, and End Results (SEER) program.

A retrospective analysis of 288,132 malignant HNC cases from the SEER program (2000-2021) was performed. Survival analyses were restricted to cases diagnosed between 2000 and 2015 to allow for adequate follow-up. The anatomical sites included the salivary gland, larynx, the oral cavity, the lip, the tongue, the nasopharynx, the oropharynx, and the hypopharynx. Trends in tumor proportion, clinical stage, and treatment modality were assessed using linear regression. Five-year survival trends were analyzed using multivariate logistic regression.

The proportion of tongue-cancer diagnoses increased by 12.2% ( p  < 0.001), while that of laryngeal cancer decreased by 10.0% ( p  < 0.001). Treatment patterns shifted significantly, with the rates of surgery combined with radiation (-11.0%; p  < 0.001) and radiation alone (-7.6%; p  < 0.001) declining, while that of chemoradiation increased (+16.9%; p  < 0.001). The 5-year survival rates improved for hypopharynx (8.5%; p  < 0.001), tongue (8.5%; p  < 0.001), and oropharynx (8.0%; p  < 0.01) cancers.

The management of HNC has shifted toward multimodal therapies involving chemotherapy, coinciding with improved survival in pharyngeal and oral subsites. The rising proportion of tongue and oropharyngeal cases may reflect changes in underlying etiologic factors, including human papillomavirus (HPV)-associated disease, although HPV-specific effects cannot be directly assessed in the SEER program.