Prognostic Models in Head and Neck Oncology: Predictors and dynamics

Head and neck malignancies originating from the mucosal lining of the upper aerodigestive tract (head and neck squamous cell carcinoma’s: HNSCC’s) and the salivary glands make up nearly 5% of the total number of malignant tumours in the Netherlands. Variation of incidence trends between sites exist1, the general incidence of HNSCC’s is 17/100,000; the incidence of malignant salivary gland tumours 0.7/100,000 (Netherlands Cancer Registry). In this thesis we discuss prognostics in both types of cancer, although we focus on HNSCC’s. Once diagnosed with head and neck cancer, the prognosis (likely outcome of the disease) plays an enormous role in choosing treatment options and informing patients. Generally, survival rates for patients vary depending on the type and the stage (extent) of the cancer involved. The fi ve-years survival rate of patients (the percentage of patients who survive at least fi ve years after the cancer is detected) with HNSCC is around 50%. For those with salivary gland cancer this fi gure is highly dependent on the type of tumour and diff ers between 30% to nearly 100%. The prognosis at the time of diagnosis of cancer is taken into account in the choice of treatment. When it comes to informing patients about their prognosis, physicians also incorporate events such as staying free for cancer or the occurrence of a non related health event (eg. myocardial infarction) during follow up. The methods of determination of prognosis, the way prognosis changes over time and the way in which prognosis should be discussed with patients are the central themes of this thesis. This introduction aims to explore the concept of prognosis, the fallibility of prognostic factors, the statistical methods used when working with prognostic factors and the role prognosis plays in the process of decision-making. Finally, we will state the central hypotheses for this thesis.

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