Open AccessSocioeconomic factors and survival in patients with non‐metastatic head and neck squamous cell carcinoma
Author(s) -
Xu Cheng,
Chen YuPei,
Liu Xu,
Tang LingLong,
Chen Lei,
Mao YanPing,
Zhang Yuan,
Guo Rui,
Zhou GuanQun,
Li WenFei,
Lin AiHua,
Sun Ying,
Ma Jun
Publication year - 2017
Publication title -
cancer science
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.035
H-Index - 141
eISSN - 1349-7006
pISSN - 1347-9032
DOI - 10.1111/cas.13250
Subject(s) - socioeconomic status , marital status , medicine , nomogram , proportional hazards model , demography , epidemiology , household income , multivariate analysis , surveillance, epidemiology, and end results , oncology , cancer registry , environmental health , population , archaeology , sociology , history
The effect of socioeconomic factors on receipt of definitive treatment and survival outcomes in non‐metastatic head and neck squamous cell carcinoma ( HNSCC ) remains unclear. Eligible patients ( n = 37 995) were identified from the United States Surveillance, Epidemiology and End Results ( SEER ) database between 2007 and 2012. Socioeconomic factors (i.e., median household income, education level, unemployment rate, insurance status, marital status and residence) were included in univariate/multivariate Cox regression analysis; validated factors were used to generate nomograms for cause‐specific survival ( CSS ) and overall survival ( OS ), and a prognostic score model for risk stratification. Low‐ and high‐risk groups were compared for all cancer subsites. Impact of race/ethnicity on survival was investigated in each risk group. Marital status, median household income and insurance status were included in the nomograms for CSS and OS , which had higher c‐indexes than the 6th edition TNM staging system (all P < 0.001). Based on three disadvantageous socioeconomic factors (i.e., unmarried status, uninsured status, median household income < US $65 394), the prognostic score model generated four risk subgroups with scores of 0, 1, 2 or 3, which had significantly separated CSS / OS curves (all P < 0.001). Low‐risk patients (score 0–1) were more likely to receive definitive treatment and obtain better CSS / OS than high‐risk patients (score 2–3). Chinese and non‐Hispanic black patients with high‐risk socioeconomic status had best and poorest CSS / OS , respectively. Therefore, marital status, median household income and insurance status have significance for predicting survival outcomes. Low‐risk socioeconomic status and Chinese race/ethnicity confer protective effects in HNSCC .