Trend Analysis Of Causes Of Death In Patients With Head And Neck Squamous Cell Carcinoma

Background and Objective:As cancer survivors continue to increase,the number of deaths from non primary cancers is also increasing.An understanding of the leading causes of death in patients with head and neck squamous cell carcinoma(HNSCC)would be helpful to inform doctors,patients,and healthcare providers to formulate reasonable measures of medical care and disease prevention and control,and to provide reference for the health management of patients with head and neck squamous cell carcinoma.However,there is a lake of comprehensive studies on leading causes of death in these survivors.Therefore,we investigated the trends and risk factors for major causes of death in patients with HNSCC.Methods:Causes of death in HNSCC were obtained from the Surveillance,Epidemiology,and End Results(SEER)registries.We used the Fine and Gray competing risks regression model to estimate the 5year cumulative incidence of cause specific mortality,with observations censored at the end of follow up and death from other causes treated as competing events.Competing risks regression models were used to assess independent predictors of cause specific mortality.The above statistics are realized by Stata 14.0 and R 3.5.2version software.The trend in the cumulative mortality was measured by annual percentage changes(APCs),which was calculated using a linear regression model.The analysis was performed by Joinpoint Regression Programm 4.7.0 software(National Cancer Research,USA).Results:By analyzing the 164,009 patients with head and neck tumors collected in the SEER 18 database from 2000 to 2016,during which 48,297 patients died,We showed a rapid accumulation of HNSCC prevalence.Among 48297 deaths identified,the ten leading causes were: HNSCC,heart disease,lung cancer,chronic obstructive pulmonary disease(COPD),cerebrovascular disease,pneumonia & influenza,accidents & adverse effects,esophagus cancer,chronic liver diseases,and septicemia.Non HNSCC deaths surpassed HNSCC deaths 4 years after cancer diagnosis.There was a significant decline in the 5 year cumulative mortality from HNSCC,heart disease,lung cancer,COPD,cerebrovascular disease,and esophagus cancer.The risks of mortality from the ten leading causes varied with patient characteristics.Conclusion:1.The ten leading causes of death combined are responsible for 83.9% of deaths in the HNSCC cohort,ranked by primary cancer,heart diseases,lung cancer,COPD,cerebrovascular diseases,pneumonia & influenza,accidents & adverse effects,esophagus cancer,septicemia,and chronic liver disease.2.Over the study period,a significant decline was observed in the 5-year cumulative incidence of mortality due to primary cancer,heart diseases,lung cancer,COPD,cerebrovascular disease,and esophagus cancer,whereas no significant change was observed in mortality due to the other four causes.3.The risks of mortality due to the ten leading causes vary with age at diagnosis,sex,race,primary cancer site,stage,and surgery.4.Our findings are helpful to inform further research and intervention efforts,and to promote health in the rapidly-growing survivors of HNSCC.