Results
Data was collected from 854 patients, seen between 2015 and 2017, with 865 reported tumours. Eleven patients had two separate primaries at the time of diagnosis. There were 603 (71%) males and 251 (29%) females. The male to female ratio was 2.4:1. The age range was 10-89 years (median age 58 years). Table 1, shows the distribution of patients for each age group.
Smoking was a risk factor in 737 (86.3%), alcohol in 634 (74.2%) with smoking and alcohol in 620 (72.6%) of patients. Fifty-six (9%) were HIV positive, 721 (84%) were negative and 77 (7%) had unknown HIV status.
The ECOG performance status was recorded as a score of 0 to 5. A score of zero indicates a fully active patient, 1 restricted strenuous activity but able to carry out light duties, 2 is capable of self-care but rests for up to 50% of the day, 3 is capable of limited self-care and rests for The scores were 1 in 460 (53.86%), 2 in 232 (27.17%), 3 in 128 (14.89%), 4 in 27 (3.16%) and unknown in two (0.23%) patients.
Table 2 and 3 shows uniform patient fees schedule (UPFS), which is a surrogate for the socio-economic status of patients. Majority of thepatients had no reported income.
The most common site was the oral cavity (n=320) followed by the larynx (n= 188) and the oropharynx (n=167). The most common sub-site was the anterior tongue (n=137) followed by the supraglottic larynx (n=98). Appendix 1 shows the distribution of disease according to anatomical site.
The most predominate histological type was squamous cell carcinoma (SCC), which accounted for 92.6% (n=791) of all cases. In patients who had two synchronous primaries, both primaries were found to be SCC.
There were 20.37% (n=174) grade I or well differentiated SCC, 47.90% (n=409) grade II or moderately differentiated SCC, 6.79% (n=58) grade III or poorly differentiated SCC and 150 17.56% (n=150) SCC with unknown histologic grade.
Of 167 patients with oropharyngeal primaries, 9.58% (n=16) patients had p16 positive SCC (with p16 antibody showing nuclear and cytoplasmic positivity in more than 70% of the tumour cells), 46.70% (n=78) were p16 negative and the p16 status was unknown in 43.7% (n=73). Three (18.75%) of the p16 positive oropharyngeal lesions were HPV-DNA positive by Polymerase Chain Reaction (PCR).
The majority of patients presented with locally advanced disease. 466 (53.87%) had stage IVA disease at presentation. Eight patients had two primaries at the time of diagnosis and both of these were stage IVA. Patients with two primaries had each primary staged separately. Distant metastases were diagnosed in 53 patients, of which 35 had lung metastases, 10 had multiple sites, two presented with bone metastases and six patients had other sites for distant disease. Table 4. shows the sub-site distribution according to the TNM stage grouping.
449 (52.58%) patients were treated with radical/curative intent and 405 (47.42%) received palliative treatment. In the radical treatment group one patient had surgery followed by definitive chemoradiation and one patient only received induction chemotherapy. Four of the 11 patients with second primaries were treated with palliative intent. Table 5. shows the distribution of various treatment modalities, according to treatment intent.