Risk factors for early mortality and impaired quality of life in oral cavity cancer - head and neck cancer register study.

Background and purpose: Treatment of locoregionally advanced oral cavity cancer (OCC) is associated with treatment-related complications, functional deficits, and even early mortality. High-quality register data could help in choosing between curative and non-curative intent treatment options.

Materials and methods: The Helsinki Head and Neck Cancer Register (HHNCR) is linked with the EORTC QLQ-H&N35 questionnaire automatically sent to all patients at diagnosis and predetermined intervals. We analyzed pretreatment data of all patients diagnosed with OCC during 2018-2023, focusing on risk factors for early mortality and impaired health-related quality of life after curative-intent treatment.

Results: Of 597 patients, 556 (93%) were treated with curative intent. Thirty-nine (7.0%) patients died within 6 months after diagnosis. The independent risk-factors for 6-month mortality identified in multivariable analysis were T3 stage (OR 8.3 [2.6-26.5], p < 0.001), T4 stage (OR 8.2 [2.5-26.8], p < 0.001), N3 stage (OR 10.6 [3.2-35.1], p < 0.001), and Adult Comorbidity Evaluation (ACE)-27 score 2-3 (OR 5.5 [2.4-12.5], p < 0.001). These risk-factors were used to create a predictive risk score for early death. Younger, healthier patients had significantly higher EORTC QLQ-H&N35 response rates compared with older patients with comorbidities. Six months after diagnosis, patients with a stage III-IV tumor had significantly higher scores in 15 of 18 items, compared with patients with a stage I-II tumor.

Interpretation: Early mortality was associated with advanced tumor (T) and nodal (N) stage, and increased pretreatment comorbidity (ACE-27) scores. The strongest predictor for impaired quality of life was locoregionally advanced disease.