Determinants of long-term survival in a population-based cohort study of patients with head and neck cancer from Scotland

Background: We investigated long-term survival from head and neck cancer (HNC) using different survival approaches. Methods: Patients were followed-up from the Scottish Audit of Head and Neck Cancer. Overall survival and disease-specific survival were calculated using the Kaplan–Meier method. Net survival was calculated by the Pohar-Perme method.Mutually adjusted Cox proportional hazards models were used to determine the predictors of survival. Results: A total of 1820 patients were included in the analyses. Overall survival at 12 years was 26.3% (24.3%, 28.3%). Disease-specific survival at 12 years was 56.9% (54.3%, 59.4%). Net survival at 12 years was 41.4% (37.6%, 45.1%). Conclusion: Determinants associated with long-term survival included age, stage,treatment modality, WHO performance status, alcohol consumption, smoking behavior, and anatomical site. We recommend that net survival is used for long-term outcomes for HNC patients—it disentangles other causes of death, which are over estimated in overall survival and underestimated in disease-specific survival