This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (4)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Oncology  • Head & Neck Cancer  • Endocrine Disease of Head & Neck  • Neoplasms of Head & Neck  • Endocrine Diseases  • Thyroid/ Parathyroid Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

Marc Nelson, MD; Aleck Hercbergs, MD; Lisa Rybicki, MS; Marshall Strome, MD

Arch Otolaryngol Head Neck Surg. 2006;132:1041-1046.

Objective  To determine if the development of hypothyroidism has an effect on the outcome of advanced-stage head and neck squamous cell carcinoma.

Design  Retrospective database analysis.

Setting  Tertiary care center.

Patients  The study population comprised 155 patients with advanced-stage head and neck squamous cell carcinoma.

Interventions  Patients underwent radiation therapy alone or in combination with chemotherapy and surgery when indicated.

Main Outcome Measures  Kaplan-Meier analysis was used to assess survival, not adjusting for timing of the detection of hypothyroidism. The following 2 analyses were then performed to adjust for the timing of detection: (1) hypothyroidism was assessed as a time-varying covariate in a Cox proportional hazards model and (2) a landmark analysis was conducted at 9, 12, 15, 18, 21, and 24 months using the Kaplan-Meier method.

Results  Of the 155 patients, 59 developed hypothyroidism, defined as a thyrotropin level greater than 5.5 mIU/L (institutional value). An unadjusted Kaplan-Meier analysis indicated that patients who develop hypothyroidism have significantly better survival than patients who do not (P<.001, log-rank test). After adjusting for the timing of hypothyroidism, a Cox proportional hazards analysis indicated that survival was better, but not statistically significant, for patients who developed hypothyroidism (hazard ratio, 0.62; P = .12); results from a landmark analysis supported this finding (P values ranged from .11 to .19).

Conclusions  Development of hypothyroidism may be associated with improved survival and increased recurrence-free survival. Larger, prospective studies appear warranted to test the beneficial effect of hypothyroidism.

Author Affiliations: Head and Neck Institute (Drs Nelson and Strome), and Departments of Radiation Oncology (Dr Hercbergs) and Biostatistics (Ms Rybicki), Cleveland Clinic Foundation, Cleveland, Ohio.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Hypothyroidism in the Patient With Cancer: How Much Thyroid Supplementation Is "Safe"?
Aleck Hercbergs and Paul Davis
Arch Otolaryngol Head Neck Surg. 2007;133(6):625-626.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Thyroid Function and Cancer Risk: A Prospective Population Study
Hellevik et al.
Cancer Epidemiol. Biomarkers Prev. 2009;18:570-574.
ABSTRACT | FULL TEXT  

Documentation of Thyroid Function in Clinical Studies With Sunitinib: Why Does It Matter?
Garfield et al.
JCO 2008;26:5131-5132.
FULL TEXT  

The Association of Thyroid Dysfunction with All-Cause and Circulatory Mortality: Is There a Causal Relationship?
Volzke et al.
J. Clin. Endocrinol. Metab. 2007;92:2421-2429.
ABSTRACT | FULL TEXT  

Re: Hypothyroidism in Patients With Metastatic Renal Cell Carcinoma Treated With Sunitinib
Garfield et al.
JNCI J Natl Cancer Inst 2007;99:975-976.
FULL TEXT  

Hypothyroidism in the Patient With Cancer: How Much Thyroid Supplementation Is "Safe"?
Hercbergs and Davis
Arch Otolaryngol Head Neck Surg 2007;133:625-626.
FULL TEXT