Objective: Head and neck squamous cell carcinoma (HNSCC) is rare in patients under 40 years old. However, it is thought to be a more aggressive disease in this age group, and perhaps increasing in incidence. We sought to compare outcomes for young patients with HNSCC to those of older patients.
Design & Patients: A chart review was performed on all patients under 40 treated for p16-negative HNSCC (n=37). A randomized stage and subsite matched cohort aged 55-65 was analyzed for comparison (n=74). SEER9 data were evaluated to note changes in incidence of HNSCC in young patients from 1973-2014.
Results: 55% of young patients were never smokers vs. 12% of older patients (p<0.001) and 41% were female vs. 22% of older patients (p=0.045). 73% of the young patients had oral tongue cancers. The young patients had better 3-year overall survival than the older group (94% vs. 80%, respectively) but worse 3-year similar disease-free survival (63% vs. 77%, respectively). 56% of young patients had tumors with adverse histologic features vs. 39% of older patients (p=0.10). The young patients demonstrated a superior 5 year conditional survival from date of recurrence (80% vs 38%, p=0.031) when compared to the older cohort. A review of the SEER database suggests an increase in tongue cancer amongst young patients, but this trend may be confounded by inclusion of HPV-related tongue base cancers.
Conclusions: Despite its limitations, this study supports the idea that young patients who develop HNSCC tend to have more aggressive disease, which may recur earlier but in patients who better tolerate repeated treatment, presumably due to better overall health and nutritional status.