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The National Cancer Data Base Report on Cancer of the Head and Neck

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The National Cancer Data Base Report on Cancer of the Head and Neck ORIGINAL ARTICLE The National Cancer Data Base Report on Cancer of the Head and Neck Henry T. Hoffman, MD; Lucy Hynds Karnell, PhD; Gerry F. Funk, MD; Robert A. Robinson, MD; Herman R. Menck, MBA Background: The National Cancer Data Base (NCDB), Results: The largest proportion of cases arose in the lar- a large sample of cancer cases accrued from hospital- ynx (20.9%) and oral cavity, including lip (17.6%) and based cancer registries, is sponsored by the Commis- thyroid gland (15.8%). Squamous cell carcinoma (55.8%) sion on Cancer of the American College of Surgeons and was the most common histological finding, followed by the American Cancer Society. The NCDB permits a de- adenocarcinoma (19.4%) and lymphoma (15.1%). In- tailed analysis of case-mix, treatment, and outcome vari- come level (low), race (African American), and tumor ables. grade (poorly differentiated) were most notably associ- ated with advanced stage. Treatment was most com- Objective: To provide an overview of the contempo- monly surgery alone (32.4%), combined surgery with ir- rary status of the subset of patients with head and neck radiation (25.0%), and irradiation alone (18.9%). Overall cancer in the United States. 5-year, disease-specific survival was 64.0%. Cancer of the lip demonstrated the best survival (91.1%) and cancer Methods: The NCDB, which obtains data from US as of the hypopharynx the worst survival (31.4%). well as Canadian and Puerto Rican hospitals, accrued 4 583 455 cases of cancer between 1985 and 1994. Of these Conclusions: This NCDB analysis of cancer of the head cases, 301 350 (6.6%) originated in the head and neck. and neck provides a contemporary overview of head and We address 295 022 cases of head and neck cancer lim- neck cancer in the United States. It also serves to intro- ited to the 50 United States and District of Columbia. Cases duce a series of NCDB articles that address specific ana- were segregated into an earlier group (1985-1989) to per- tomical sites and histological types through separate, de- mit 5-year follow-up and into a later group (1990- tailed analysis. 1994) to analyze a more contemporary group. Compari- son between both periods permits identification of trends. Arch Otolaryngol Head Neck Surg. 1998;124:951-962 HE NATIONAL Cancer Data Although there is no current system Base (NCDB) is a large for gathering incidence data for the en- sample of cancer cases ac- tire United States, a population-based reg- crued from hospital-based istry termed the Surveillance, Epidemiol- cancer registries in the ogy, and End Results program9 exists to TUnited States. This database is jointly spon- provide estimates of cancer-related inci- sored by the American College of Sur- dence and mortality. This program, which geons’ Commission on Cancer (COC) and was mandated by the National Cancer Act the American Cancer Society. It is de- of 1971, currently surveys 14 distinct signed to provide descriptive information population groups representing approxi- about the demographic, management, and mately 14% of the population.10 outcome variables characterizing cancers The Surveillance, Epidemiology, and From the Departments of involving all ethnic groups in all 50 states. End Results and the NCDB programs are Otolaryngology–Head and National cancer registries have been func- separate cancer data systems that are de- Neck Surgery (Drs Hoffman, tioning for many years in other countries. signed for different purposes and rely on Karnell, and Funk) and The most highly developed registries cur- different methodologies.11 The Surveil- Pathology (Dr Robinson), rently exist in European countries with lance, Epidemiology, and End Results pro- University of Iowa Hospitals small populations that include Sweden, gram is a population-based registry that is and Clinics, Iowa City; and 1-6 National Cancer Data Base, Norway, and Denmark. In 1988 the intended to accurately sample a measur- Commission on Cancer of the United States established its national clini- able segment of the US population. The American College of Surgeons, cal cancer registry with the creation of the NCDB is a hospital-based registry that Chicago, Ill (Mr Menck). NCDB.7,8 monitors patterns from a much larger pa- ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 124, SEP 1998 951 ©1998 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 09/29/2021 MATERIALS AND METHODS cancer. Although patients are followed up longitudinally and recurrent disease is added to their record if identified, the The NCDB data are collected yearly on a voluntary basis NCDB does not collect records of patients who were iden- through a computerized format from hospital-based can- tified at the reporting hospital with recurrent disease. To en- cer registries.7 The NCDB cancer registry data are coded sure that the database does not include more than 1 record according to schemata published in the Data Acquisition for each patient (eg, a patient having received primary treat- Manual,14,15 the first through the fourth editions of the Ameri- ment at 2 different reporting hospitals), an algorithm based can Joint Committee on Cancer (AJCC) Manual for Stag- on patient and disease characteristics was used to identify ing of Cancer,16-19 and the second edition of the Interna- and remove these duplicate records. tional Classification of Disease for Oncology (ICD-O 2).20 Patterns of presentation and treatment across time are The head and neck cancer data set was defined by the investigated by dividing the years of diagnosis into an ear- ICD-O 2 topography codes and included the lip, oral cavity, lier period (1985-1989) and a later period (1990-1994). oropharynx, nasopharynx, hypopharynx, and major sali- Case-mix characteristics and treatment are stratified by ana- vary glands (C00.0-14.8), sinonasal tract (C30.0, 31.0- tomical site and extent of disease, when appropriate, to pro- 31.9), and larynx (C32.0-32.9). Although the lip is included vide a more detailed analysis. with other subsites in the oral cavity according to AJCC stag- Patients were classified by geographic regions that were ing, its behavior is sufficiently different from the remainder organized by grouping individual states into 6 regions as of the oral cavity that it was considered separately in this ar- previously reported.7 Income was inferred for each pa- ticle. Other head and neck sites included in the head and neck tient based on the average family income of the ZIP code data set were the middle ear (C30.1), trachea (C33.9), eye of residence. To compare the level of income of patients and ocular adnexa (C69.0-69.9), olfactory nerve (C72.2), thy- with head and neck cancer with the income of all patients roid gland (C73.9), parathyroid glands (C75.0), and other with cancer within the NCDB, 3 income groups were cre- endocrine gland–related structures (C75.2, C75.4-75.9), ex- ated. These income groups were chosen to approximate the cluding the pineal and pituitary glands. Additional sites iso- lowest 10%, the highest 10%, and intermediate incomes for lated to the head and neck included bones, joints, and ar- all NCDB cases.21 The low-income group included pa- ticular cartilages (C41.0-41.9), peripheral nerves and tients with annual incomes of less than $20 000 that rep- autonomic nervous system (C47.0), connective, subcutane- resented 11.2% of the NCDB data set. The high-income ous, and other soft tissues (C49.0), and lymph nodes (C77.0). group included patients with annual incomes of $47 000 The nonspecific sites within the head and neck classified as or more, which represented 10.3% of the NCDB data set. “other” and “ill-defined” (C76.0) were also included. Extent of disease was represented by “combined stage” The reporting hospitals provide only those cases that that reflects pathologic staging (pAJCC stage group) when were diagnosed and/or treated at their institute as a primary it was available through the reporting cancer registrar’s tient base derived from community hospitals, teaching the potential to be affected by a selection bias that could hospitals, and cancer centers.8 skew the sampling of cases. Despite these potential limi- The goal of the NCDB is to improve cancer man- tations in data collection, the large numbers of cases ac- agement through analysis of data characterizing a large crued offer demographic, management, and outcome in- proportion of all cases of cancer in the United States. To formation from a broad spectrum of treating facilities in help achieve this goal, the NCDB has established the ob- the United States. A recent comparison between NCDB and jective to collect 80% of all US incident cancers by the Surveillance, Epidemiology, and End Results data identi- year 2000. The first call for data by the NCDB yielded fied patterns that differed only marginally in the analysis an estimated 24% of all cancer cases diagnosed in 1985. of breast, colorectal, lung, and prostate cancers evaluated This sample represented 232 577 cases reported from 501 for the diagnostic year 1992.11 hospitals. The number of participating NCDB hospitals We address the subset of the NCDB cancer cases lim- and cases accrued for the year 1994 increased to 1227 ited to the head and neck. Most cancers commonly hospitals reporting 689 714 cases, reflecting an esti- grouped as head and neck malignancies arise from the mated 57% of all cancer cases. This increase in report- mucosal lining of the upper aerodigestive tract and the ing over the past 9 years has paralleled an increase in the adjacent salivary glands. Thyroid, parathyroid, sinona- number of hospital cancer registries that have become sal, and ocular cancers are also considered cancers of the computerized.
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