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Henry T. Hoffman, MD; Lucy Hynds Karnell, PhD; Gerry F. Funk, MD; Robert A. Robinson, MD; Herman R. Menck, MBA

Arch Otolaryngol Head Neck Surg. 1998;124:951-962.

Background  The National Cancer Data Base (NCDB), a large sample of cancer cases accrued from hospital-based cancer registries, is sponsored by the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The NCDB permits a detailed analysis of case-mix, treatment, and outcome variables.

Objective  To provide an overview of the contemporary status of the subset of patients with head and neck cancer in the United States.

Methods  The NCDB, which obtains data from US as well as Canadian and Puerto Rican hospitals, accrued 4583455 cases of cancer between 1985 and 1994. Of these cases, 301350 (6.6%) originated in the head and neck. We address 295022 cases of head and neck cancer limited to the 50 United States and District of Columbia. Cases were segregated into an earlier group (1985-1989) to permit 5-year follow-up and into a later group (1990-1994) to analyze a more contemporary group. Comparison between both periods permits identification of trends.

Results  The largest proportion of cases arose in the larynx (20.9%) and oral cavity, including lip (17.6%) and thyroid gland (15.8%). Squamous cell carcinoma (55.8%) was the most common histological finding, followed by adenocarcinoma (19.4%) and lymphoma (15.1%). Income level (low), race (African American), and tumor grade (poorly differentiated) were most notably associated with advanced stage. Treatment was most commonly surgery alone (32.4%), combined surgery with irradiation (25.0%), and irradiation alone (18.9%). Overall 5-year, disease-specific survival was 64.0%. Cancer of the lip demonstrated the best survival (91.1%) and cancer of the hypopharynx the worst survival (31.4%).

Conclusions  This NCDB analysis of cancer of the head and neck provides a contemporary overview of head and neck cancer in the United States. It also serves to introduce a series of NCDB articles that address specific anatomical sites and histological types through separate, detailed analysis.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Hoffman, Karnell, and Funk) and Pathology (Dr Robinson), University of Iowa Hospitals and Clinics, Iowa City; and National Cancer Data Base, Commission on Cancer of the American College of Surgeons, Chicago, Ill (Mr Menck).

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