Age as a Prognostic Factor for Head and Neck Squamous Cell Carcinoma: Should Older Patients Be Treated Differently?
Bibliographic record
Abstract
OBJECTIVE: In an aging society, one may expect to encounter more seniors with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to question the appropriateness of feasible aggressive curative treatment for these older patients. DESIGN: A retrospective study. SETTING: A tertiary head and neck surgical oncology service. METHODS: A chart review of patients with HNSCC of the oral cavity, pharynx, and larynx, 75 years or older, who were primarily treated by our service from 1990 to 1999. MAIN OUTCOME MEASURES: Demographics, pretreatment comorbidities and treatment modalities, and their related morbidity and mortality were reviewed. Special attention was given to treatment decision making and long-term outcome. RESULTS: Twenty-six males and 14 females with an average age of 82.2 years were treated. Twenty-two had stage III and IV disease. All had at least one comorbidity. Four patients had palliative radiotherapy and were dead of disease within 6 months. Among the 36 patients who were treated for cure, there were 2 postoperative deaths, 11 recurrences, and 2 cases of distant metastasis. The average lifespan of the 34 survivors (until death or end of study) was 4.7 years. CONCLUSION: HNSCC is a serious disease that often necessitates aggressive treatment. All of the patients who were medically eligible received curative treatment, with age not serving as an exclusion criterion. The average survival almost approached the expected lifespan of a normal cohort (4.7 vs 6.3 years, respectively). Seniors with HNSCC may benefit from curative treatment, and exclusion should be based, as for younger subjects, on an individual basis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".