Head and neck cancer (HNC) is a preventable malignancy that continues to cause substantial morbidity and mortality worldwide. Using data from the ARCAGE and Rome studies, we investigated the main predictors of survival after larynx, hypopharynx and oral cavity (OC) cancers. We used the Kaplan-Meier method to estimate overall survival, and Cox proportional models to examine the relationship between survival and sociodemographic and clinical characteristics. 604 larynx, 146 hypopharynx and 460 OC cancer cases were included in this study. Over a median follow-up time of 4.6 years, nearly 50% (n = 586) of patients died. Five-year survival was 65% for larynx, 55% for OC and 35% for hypopharynx cancers. In a multivariable analysis, we observed an increased mortality risk among older (≥71 years) versus younger (≤50 years) patients with larynx/hypopharynx combined (LH) and OC cancers [HR = 1.61, 95% CI 1.09-2.38 (LH) and HR = 2.12, 95% CI 1.35-3.33 (OC)], current versus never smokers [HR = 2.67, 95% CI 1.40-5.08 (LH) and HR = 2.16, 95% CI 1.32-3.54 (OC)] and advanced versus early stage disease at diagnosis [IV versus I, HR = 2.60, 95% CI 1.78-3.79 (LH) and HR = 3.17, 95% CI 2.05-4.89 (OC)]. Survival was not associated with sex, alcohol consumption, education, oral health, p16 expression, presence of HPV infection or body mass index 2 years before cancer diagnosis. Despite advances in diagnosis and therapeutic modalities, survival after HNC remains low in Europe. In addition to the recognized prognostic effect of stage at diagnosis, smoking history and older age at diagnosis are important prognostic indicators for HNC.

Cancer Registry of Norway Oslo Norway

Cancer Research Program Rajiv Gandhi Centre for Biotechnology Thiruvananthapuram Kerala India

Cancer Surveillance Section International Agency for Research on Cancer Lyon France

Center for Oral Health Research Newcastle University Newcastle upon Tyne United Kingdom

CIBER en Epidemiología y Salud Pública Madrid Spain

Department of Cardiac Thoracic and Vascular Sciences University of Padova Padova Italy

Department of Cardiovascular and Thoracic Sciences University of Padova Padova Italy

Department of Hygiene Epidemiology and Medical Statistics University of Athens Medical School Athens Greece

Department of Otorhinolaryngology and Head and Neck Surgery 1st Faculty of Medicine Charles University of Prague Prague Czech Republic

Department of Pathology Queen Elizabeth University Hospital Glasgow United Kingdom

Department of Public Health and Community Health School of Health Professions Athens University of Applied Sciences Athens Greece

Epidemiology Group University of Aberdeen Aberdeen United Kingdom

Genetic Cancer Susceptibility Group International Agency for Research on Cancer Lyon France

Genetic Epidemiology Group International Agency for Research on Cancer Lyon France

Infections and Cancer Biology Group International Agency for Research on Cancer Lyon France

Institut Català d'Oncologia IDIBELL L'Hospitalet de Llobregat Catalonia Spain

Institute of Hygiene and Epidemiology 1st Faculty of Medicine Charles University of Prague Prage Czech Republic

Institute of Othorinolaringoiatry Università Cattolica del Sacro Cuore Fondazione Policlinico 'Agostino Gemelli' Rome Italy

Institute of Statistics Faculty of Mathematics and Computer Science University Bremen Bremen Germany

Leibniz Institute for Prevention Research and Epidemiology BIPS Bremen Germany

Ninewells Hospital and Medical School University of Dundee Dundee United Kingdom

School of Medicine Dentistry and Nursing University of Glasgow Glasgow United Kingdom

Section of Hygiene Institute of Public Health Università Cattolica del Sacro Cuore Fondazione Policlinico 'Agostino Gemelli' Rome Italy

Trinity College School of Dental Science Dublin Ireland

Unit of Cancer Epidemiology Aviano National Cancer Institute IRCCS Aviano Italy

Unit of Cancer Epidemiology Department of Medical Sciences University of Turin Turin Italy

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