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Head and Neck Surgery

Factors Related to Not Being Offered Surgery for cT1N0M0 HNSCC

Tuesday, October 3, 2023
10:09 AM - 10:15 AM East Coast USA Time
Location: 201AB

    Presenting Author(s)

  • Shivee Gilja, BS

    Medical Student
    Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
    New York, NY, United States

    • Co-Author(s)

  • Diana N. Kirke, MD

    Assistant Professor
    Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
    New York, NY, United States

    • Senior Author(s)

  • SR

    Scott A. Roof, MD

    Assistant Professor
    Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai
    New York, NY, United States

Disclosure(s):
Diana N. Kirke, MD: No relevant relationships to disclose.
Scott A. Roof, MD: No relevant relationships to disclose.
Introduction: Current treatment guidelines for cT1N0M0 head and neck squamous cell carcinoma (HNSCC) recommend surgery or radiotherapy. This study sought to evaluate predictors of not being offered surgery as primary therapy for cT1N0M0 HNSCC.

Methods: Patients with cT1N0M0 HNSCC in the National Cancer Database between 2004-2020 were stratified by whether or not their provider offered surgery as part of planned first course of treatment in this retrospective case-control study. Patients in whom surgery was contraindicated due to patient risk factors or who received palliative therapy were excluded. Multivariable-adjusted logistic regression was used to evaluate factors associated with being offered surgery as primary therapy.

Results: Of the 58,541 patients in this study, 19,686 (33.6%) were not offered surgery as primary therapy. 15,746 (82.5%) patients received definitive radiotherapy, 234 (1.2%) received chemotherapy, 863 (4.5%) received chemoradiation, and 2,240 (11.7%) received no treatment. 2.3% (453/19,109) of patients with oral cavity tumors were not offered surgery, less than any other head and neck site (p < 0.001). Rates of not being offered surgery decreased from 42.3% in 2004 to 33.4% in 2020 (p < 0.001). After multivariable adjustment, the strongest independent predictors of not being offered surgery included uninsured status compared to private insurance (OR: 1.57, 95% CI: 1.37-1.81, p< 0.001), treatment at a community compared to academic centers (OR: 1.56, 95% CI: 1.48-1.64, p< 0.001), and black race (OR: 1.28, 95% CI: 1.19-1.39, p< 0.001). Other significant predictors of not being offered surgery included household income below median, male sex, government insurance compared to private insurance, lower comorbidity score, and urban residence compared to metropolitan.

Conclusions: In this national analysis of the patterns of care for patients with cT1N0M0 HNSCC, black, uninsured, and community center patients were less likely to be offered surgery than their counterparts. These results highlight underlying disparities in the treatment of patients with HNSCC that should be further explored.