Predictive Scoring Analysis for Identifying Head and Neck Squamous Cell Cancer

Background: Head and neck squamous cell carcinoma (HNSCC) accounts for an estimated 450,000 deaths annually worldwide, presenting a significant clinical burden (1). Poor survival rates are largely due to the lack of reliable screening tools for early detection, as current methods offer limited insight into tumor invasiveness and metastasis potentials. While previous studies have explored HNSCC risk factors, predicting disease’s likelihood remains challenging due to lack of reliable screening tools. This retrospective study aims to creating a risk stratification scoring system for HNSCC, ultimately improves early detection and management for high-risk patients. Methods: We developed a risk scoring system using data from the health system Geisinger, incorporating demographic and comorbidity factors such as sex, age, race, BMI, HPV history, smoking, alcohol use, diabetes, and prior diagnoses of leukoplakia or erythroplakia. The study included patients age 18 and older diagnosed with HNSCC between 2000 and 2024, excluding those with HIV/AIDS. Categorical variables were summarized with frequencies and percentages, while medians were reported for continuous variables. We used multiple logistic regression and descriptive analysis to assess the association between each risk factor and HNSCC development. Results: Of the total 2,435 patients who were diagnosed with HNSCC, 1,607 (66.0%) are patients age 60 years or older at diagnosis. There are 620 females (25.5%) and 1,815 males (74.5%). Mean BMI is 27.5 (SD 7.0) with 707 patients (29.0%) having obesity. One thousand four hundred eighteen patients (58.2%) use tobacco, 949 patients (39.0%) use alcohol, 605 patients (24.8%) have diabetes, 62 patients (2.5%) have history of leukoplakia or erythroplakia, 14 patients (0.6%) have history of HPV, and 59 patients (2.4%) were previously diagnosed with HNSCC. Among 778 patients with known pack years, 109 (14.0%) smoked less than 10 pack years, 669 (86%) smoked at least 10 pack years, and 536 smoked at least 20 pack years (68.9%). Among 227 patients with known alcohol use frequency, 123 (54.2%) consumed less than 10 drinks per week and 104 (45.8%) consumed at least 10 drinks per week. Type/location of tumor: 621 (25.5%) tongue cancer, 358 (14.7%) tonsillar cancer, 46 (1.9%) nasopharyngeal cancer, 72 (3.0%) oropharyngeal cancer, 54 (2.2%) palatine cancer, 202 (8.3%) lip cancer, 60 (2.5%) gum cancer, 114 (4.7%) floor of mouth cancer, 270 (11.1%) glottic cancer, 259 (10.6%) supraglottic cancer, 54 (2.2%) pyriform sinus cancer, and 325 (13.3%) others. Patients who scored 6 or higher are classified as high risk, 4–6 is medium risk, and 1–3 is low risk of HNSCC. Conclusion: Tobacco use is identified as the highest risk factor that contributes to developing HNSCC. Patients scoring 6 or more points should undergo more rigorous and proactive screening for early detection. Given the severity of HNSCC, implementing this scoring system is crucial for reducing undiagnosed cases and improving patient outcomes. Future study should focus on which factors are associated with earlier onset of HNSCC and prediction of survival rate based on risk scores.