The univariate and multivariate analyses of 26 patients with HNS showed significant correlation between age ≥ 55 years and shorter overall survival, as well as a significant relationship between the absence of chemotherapy and worse local recurrence-free survival.
HNSs have been divided into those of the bone and those of the soft tissue [1, 2]. Although the TNM staging system has been broadly accepted as a useful predictor for various malignant tumors, there remains a lack of clarification for soft tissue sarcomas of the head and neck in the staging system outlined in the eighth edition of the UICC TNM classification [13]. Previous studies that included a larger cohort of 12,755 patients mentioned that further data accumulation for predictors of HNS due to rare tumors and various histological subtypes is needed [1–3]. Indeed, Ketabachi et al. had reported that the surgical margin was a survival predictor for 25 patients with HNS [7].
Age has been shown to predict overall survival of patients with HNS in both single and multi-institution studies [4, 5]. Indeed, single institution study of 186 patients with HNS showed close relationship between age and overall survival [4]. Moreover, a multi-institution study of 214 patients with HNS from the Society of Head and Neck Surgeons showed that age < 18 years was significant predictor for overall survival [5]. Therefore, the finding of a significant relationship between higher age and shorter overall survival in the present study is in good agreement with the findings of previous studies [4, 5]. Although the two previous studies did not mention the method used to determine the cut-off ages, the present study used ROC analysis for this purpose [4, 5].
Although the value of chemotherapy for HNS is an ongoing debate [1, 2], single and multi-institution studies have shown that chemotherapy improves the survival outcomes for patients with sarcoma, including those with HNS [8, 9, 14]. Boon et al. reported the absence of chemotherapy led to higher local recurrence in 77 patients with osteosarcoma in head and neck [8]. Furthermore, Chen YM et al. also showed that the absence of chemotherapy was associated with shorter overall survival in 157 patients with head and neck osteosarcoma [9]. The European Organization for Research and Treatment of Cancer-Soft Tissue and Sarcoma group showed that IFM-based chemotherapy was an independent predictor in patients with advanced soft tissue sarcoma [14]. The findings of a significant relationship between the absence of chemotherapy and shorter local recurrence-free survival in the present study is consistent with the results of previous reports [8, 9, 14].
The present study was limited by its retrospective design and relatively small number of subjects. Although the multivariate analysis of the present study showed a significant association between age and overall survival after adjusting for the absence/presence of chemotherapy, a larger cohort of subjects is necessary of determine whether age could be used as a useful predictor to guide treatment.