Alcohol intake, tobacco smoking, and esophageal adenocarcinoma survival: a molecular pathology epidemiology cohort study

Abstract

Purpose To investigate the association between cigarette smoking, alcohol consumption, and esophageal adenocarcinoma survival, including stratified analysis by selected prognostic biomarkers. Methods A population-representative sample of 130 esophageal adenocarcinoma patients (n = 130) treated at the Northern Ireland Cancer Centre between 2004 and 2012. Cox proportional hazards models were applied to evaluate associations between smoking status, alcohol intake, and survival. Secondary analyses investigated these associations across categories of p53, HER2, CD8, and GLUT-1 biomarker expression. Results In esophageal adenocarcinoma patients, there was a significantly increased risk of cancer-specific mortality in ever, compared to never, alcohol drinkers in unadjusted (HR 1.96 95% CI 1.13-3.38) but not adjusted (HR 1.70 95% CI 0.95-3.04) analysis. This increased risk of death observed for alcohol consumers was more evident in patients with normal p53 expression, GLUT-1 positive or CD-8 positive tumors. There were no significant associations between survival and smoking status in esophageal adenocarcinoma patients. Conclusions In esophageal adenocarcinoma patients, cigarette smoking or alcohol consumption was not associated with a significant difference in survival in comparison with never smokers and never drinkers in fully adjusted analysis. However, in some biomarker-selected subgroups, ever-alcohol consumption was associated with a worsened survival in comparison with never drinkers. Larger studies are needed to investigate these findings, as these lifestyle habits may not only be linked to cancer risk but also cancer survival.

Clinical and Lifestyle-Related Prognostic Indicators among Esophageal Adenocarcinoma Patients Receiving Treatment at a Comprehensive Cancer Center

“…Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were obtained from models adjusted for age, sex, stage, treatment, and comorbidities. These covariates were selected a priori based on prior studies [ 12 , 16 , 17 , 18 , 19 ]. When analyzing survival associations for smoking and PA, we assessed alcohol consumption and BMI as potential confounders in the respective multivariable models.…”

“…Neoadjuvant therapy prior to surgery has become the standard-of-care for resectable tumors, providing a significant survival advantage relative to surgery alone [ 14 , 15 ]. The role of lifestyle factors in relation to survival remains less certain, with only a handful of studies reported to date [ 12 , 16 , 17 , 18 , 19 ].…”

“…A survival advantage was recently identified for physically active esophageal cancer patients [ 25 ], but was not reported in previous EAC-specific analyses [ 12 , 18 ]. Several studies have suggested that smoking and alcohol consumption are not associated with overall survival (OS) or EAC cancer-specific survival (CSS) [ 12 , 16 , 18 , 19 ]. By contrast, one recent study reported reduced survival for each 20 pack-year increase in smoking intensity [ 17 ], highlighting inconsistencies in current knowledge.…”

The research progress on the association between dietary habits and esophageal cancer: a narrative review

“…Although the geographical factors and ethnic groups in these studies have differed, the research results show some commonalities. For instance, smoking and drinking have been confirmed to be closely related to EC in many studies (7)(8)(9)(10). In China, heavy drinking and smoking are the main risk factors for EC (11), while in a Western study of ESCC, 80% of men and 40% of women had heavy drinking and smoking habits (12).…”

Research Strategies for Low-Survival Cancers

“…However, the hypotheses could still hold true that lifestyle factors may influence patient survival according to molecular characteristics of the tumor. Small studies conducted by Professor Coleman and collaborators suggest, for example, that alcohol intake and vitamin D receptor expression are associated with survival in esophageal adenocarcinoma patients [ 9 , 10 ]. As part of her Cancer Research UK Career Establishment Award, Professor Coleman is currently working with the UK-wide Oesophageal Cancer Clinical and Molecular Stratification (OCCAMS) consortium and the Precision Medicine Centre at Belfast to establish a tissue microarray cohort within their cohort of over 3000 patients.…”