Association between Preexisting Sleep Disorders and Oncologic Outcome in Patients with Oral Cavity Squamous Cell Carcinoma: A Nationwide Propensity Score—Matched Population-Based Cohort Study

Abstract

Purpose: To investigate the effects of preexisting sleep disorders on the oncologic outcomes of patients receiving standard treatments for oral squamous cell carcinoma (OSCC). Methods: The patients recruited from the Taiwan Cancer Registry Database who had received surgery for stage I–IVB OSCC. The Cox proportional hazards model was used to analyze all-cause mortality, locoregional recurrence (LRR), and distant metastasis (DM). The patients were categorized into those with and without sleep disorders (Groups 1 and 2, respectively) through propensity score matching. Results: In the multivariate Cox regression analysis, the adjusted hazard ratios for all-cause mortality, LRR, and DM for Group 1 compared with Group 2 were 1.19 (95% confidence interval (CI): 1.04–1.36; p = 0.011), 1.47 (95% CI: 1.23–1.75; p < 0.001), and 1.15 (95% CI: 1.02–1.44; p = 0.025), respectively. Conclusion: OSCC patients with sleep disorders demonstrated poorer oncologic outcomes than did those without sleep disorders. Therefore, before OSCC surgery, patients with OSCC should be screened for preexisting sleep disorders because they may serve as predictors for survival in these patients. Future studies investigating the survival benefits of pharmacological and behavioral treatments for sleep problems in patients with OSCC are warranted.

The effect of statin medication on the incidence of oral squamous cell carcinoma among betel‐nut chewers

“…The practice of betel nut chewing involves the chewing of areca nuts or betel quid (areca nuts wrapped in betel leaves), which is associated with an increased risk of several types of cancer, 5 particularly oral cavity squamous cell carcinoma (OCSCC). [6][7][8][9][10][11][12][13] In Taiwan, over 80% of head and neck cancers are OCSCC, as opposed to oropharyngeal cancer or hypopharyngeal cancer, due to the prevalence of betel nut chewing, resulting in a different pandemic cancer location in head and neck cancers compared to other countries. [6][7][8][9][10][11][12][13] The potential mechanism by which betel nut chewing increases the risk of OCSCC is believed to involve the release of copper, leading to the induction of collagen synthesis by fibroblasts.…”

“…[6][7][8][9][10][11][12][13] In Taiwan, over 80% of head and neck cancers are OCSCC, as opposed to oropharyngeal cancer or hypopharyngeal cancer, due to the prevalence of betel nut chewing, resulting in a different pandemic cancer location in head and neck cancers compared to other countries. [6][7][8][9][10][11][12][13] The potential mechanism by which betel nut chewing increases the risk of OCSCC is believed to involve the release of copper, leading to the induction of collagen synthesis by fibroblasts. 14 Betel nut chewing is also associated with a younger age of OCSCC diagnosis, poor response to chemotherapy and radiotherapy, a higher likelihood of locoregional recurrence, and shorter overall survival in OCSCC.…”

“…14 Betel nut chewing is also associated with a younger age of OCSCC diagnosis, poor response to chemotherapy and radiotherapy, a higher likelihood of locoregional recurrence, and shorter overall survival in OCSCC. [6][7][8][9][10][11][12][13] Given the high prevalence of this habit in the population, preventing the risk of OCSCC in betel nut chewers is particularly important in Taiwan. The overall survival rate for OCSCC is poor both globally and in Taiwan, with the mean age of individuals diagnosed with OCSCC in Taiwan around 50 years old, [6][7][8][9][10][11][12][13] who are often the main economic supports for their families and countries.…”

“…[6][7][8][9][10][11][12][13] Given the high prevalence of this habit in the population, preventing the risk of OCSCC in betel nut chewers is particularly important in Taiwan. The overall survival rate for OCSCC is poor both globally and in Taiwan, with the mean age of individuals diagnosed with OCSCC in Taiwan around 50 years old, [6][7][8][9][10][11][12][13] who are often the main economic supports for their families and countries. Thus, discovering an effective, safe, and long-term prophylactic drug for OCSCC in betel nut chewers is a highly desirable and crucial objective.…”

“…A long-term comparative national cohort study was carried out to examine the relationship between statin use and the risk of OCSCC in betel nut chewers, who are at high risk of OCSCC and have poor overall survival and high locoregional recurrence, particularly as a result of their betel nut chewing habits. [6][7][8][9][10][11][12][13] The study employed propensity score matching (PSM) as a means of improving understanding of the association. The objective of the study was also to assess the potential impact of specific types of statin and examine any dose-response relationship.…”