Gender Disparities in Epidemiology, Treatment, and Outcome for Head and Neck Cancer in Germany: A Population-Based Long-Term Analysis from 1996 to 2016 of the Thuringian Cancer Registry

SIMPLE SUMMARY: Head and neck cancer (HNC) comprises a heterogeneous group of cancers. Not much population-based data has been published on gender disparities related to the incidences between different age groups, subsites, tumor stages, and its effect on therapy decisions. All new HNC cases from Thuringia between 1996 and 2016 were analyzed. The incidence of head and neck cancer still was 4-fold higher in men compared to women. Incidence reached a peak for men between 60–64 years, where the incidence increased with older age in women. Male gender, higher tumor stage and subsite (worst: hypopharyngeal cancer) still had a major negative impact on the survival of the patients. Treatment decisions were different between male and female patients, especially in older patients with a tendency to less aggressive therapy. Putting all patients together, there probably was no improvement in survival beyond changes in treatment over the observation period from 1996 to 2016. ABSTRACT: This study determined with focus on gender disparity whether incidence based on age, tumor characteristics, patterns of care, and survival have changed in a population-based sample of 8288 German patients with head neck cancer (HNC) registered between 1996 and 2016 in Thuringia, a federal state in Germany. The average incidence was 26.13 ± 2.89 for men and 6.23 ± 1.11 per 100,000 population per year for women. The incidence peak for men was reached with 60–64 years (63.61 ± 9.37). Highest incidence in females was reached at ≥85 years (13.93 ± 5.87). Multimodal concepts increased over time (RR = 1.33, CI = 1.26 to 1.40). Median follow-up time was 29.10 months. Overall survival (OS) rate at 5 years was 48.5%. The multivariable analysis showed that male gender (Hazard ratio [HR] = 1.44; CI = 1.32 to 1.58), tumor subsite (worst hypopharyngeal cancer: HR = 1.32; CI = 1.19 to 1.47), and tumor stage (stage IV: HR = 3.40; CI = 3.01 to 3.85) but not the year of diagnosis (HR = 1.00; CI = 0.99 to 1.01) were independent risk factors for worse OS. Gender has an influence on incidence per age group and tumor subsite, and on treatment decision, especially in advanced stage and elderly HNC patients.