2018-19 Section 7-Neoplastic and Inflammatory Diseases of the Head and Neck eBook

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CHERAGHLOU ET AL .

FIGURE 4 Survival associated with adjuvant therapy by the presence of adverse features in patients with late-stage disease. A, Positive margins. B, Intermediate/high-grade. C, Node involvement

with improved survival for intermediate-/high-grade (HR 0.618; P < .001), margin-positive (HR 0.621; P < .001), and node-positive (HR 0.657; P < .001) cases but not for adenoid cystic (HR 0.793; P 5 .196) tumors (Figure 3). Kaplan-Meier survival curves stratified by the treatment combination for the subgroups that were positive for each of the included adverse features that was found to receive a sig- nificant survival benefit from adjuvant therapy on the previ- ous analysis are included in Figure 4. Patients with an N classification of 2 (OR 1.417; P < .001), adenoid cystic his- tology (OR 1.761; P < .001), high-grade tumors (OR 1.763; P < .001), and positive surgical margins (OR 1.362; P < .001) were more likely to be treated with adjuvant therapy (Figure 5). Nonacademic facilities were also more likely to use adjuvant therapy (OR 1.410; P < .001). Black patients (OR 0.728; P 5 .012), those aged over 70 years (OR 0.650; P 5 0.001), or with a Charlson/Deyo score of 1 (OR 0.716; P < .001) were less likely to receive adjuvant treatment. The use of adjuvant chemoradiotherapy was not associ- ated with improved survival compared with adjuvant radio- therapy alone on either multivariate (HR 1.023; P 5 .725) or propensity-score matched (HR 1.028; P 5 .705) analyses. The 5-year survival rate was 47.3% (SE 2.0) for patients who

FIGURE 5 Factors associated with the addition of adjuvant therapy to the care of patients with late-stage disease with adverse features. Note: The error bars represent 95% confidence intervals (CIs). Odds associated with N classification of 3 removed due to the size constraints for figure clarity (odds ratio 0.938; 95% CI 0.394-2.230)

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