Abstract
INTRODUCTION: Oropharyngeal squamous cell cancer (OPSCC) is a common subtype of head and neck cancer. It is generally stratified into high, intermediate, and low risk prognostic groups on the basis of HPV (human papillomavirus) status and smoking history (Ang risk stratification). Frailty has been shown to have a negative survival effect in head and neck cancer. The effect of frailty on survival in OPSCC is unknown. The aim of this study was to explore overall survival (OS) and disease-specific survival (DSS) in OPSCC based on the modified 5-item frailty index (mFI-5). METHODS: This was a retrospective cohort study of patients diagnosed with OPSCC in the West of Scotland. The mFI-5 is a validated score that categorizes patients according to their level of frailty. Univariate and multivariate survival analyses were performed. RESULTS: One thousand and one patients with OPSCC diagnosed between 2012 and 2020 were identified. The median OS was shortened in both the 'Moderately Frail' (39 months) and 'Severely Frail' groups (11 months) compared with the 'Not Frail' group (82 months) (p < 0.001). DSS was shorter in the'Severely Frail' group (16 months) compared with the'Moderately Frail' group (66 months) (p < 0.001). However, after adjustment for other characteristics including HPV and PS (World Health Organization/Eastern Cooperative Oncology Group Performance Status), frailty was not significant on multivariate analysis. CONCLUSION: Survival in patients with OPSCC decreases significantly with increasing frailty as measured by the mFI-5. However, PS and HPV status are better predictors of OS and DSS.