Heavy smoking history interacts with chemoradiotherapy for esophageal cancer prognosis: A retrospective study

Abstract

Smoking is a well-known risk factor for esophageal cancer. However, there are few reports that directly evaluate smoking as a prognostic factor for esophageal cancer. Moreover, scarce evidence is available on whether smoking interacts with major treatment modalities of esophageal cancer. In this study we retrospectively analyzed 364 patients with esophageal squamous cell cancer who were treated between 2001 and 2005 at our institution. Background characteristics, including smoking history, were analyzed as potential prognostic factors. Of the 363 patients, 76 patients (20.9%) were non-smokers or light smokers (nonheavy), whereas 287 patients (79.1%) were heavy smokers. The 5-year survival rate for non-heavy smokers and heavy smokers was 61.8% (95% confidence interval [CI]: 49.1-72.2) vs 44.6% (95% CI: 38.2-50.9), respectively. In a multivariate Cox model (adjusted for age, gender, performance status, alcohol consumption, histology, tumor length, International Union Against Cancer [UICC] stage, and treatment), the hazard ratio for heavy smokers in comparison with non-heavy smokers was 1.73 (95% CI: 1.12-2.68; P = 0.013). When we stratified by treatment method, heavy smoking was significantly associated with poor survival only in patients treated by chemoradiotherapy (hazard ratio, 2.43; 95% CI: 1.38-4.27; P = 0.002). More importantly, a statistically significant interaction between heavy smoking history and treatment modality was observed (P = 0.041). Our results indicated that smoking history is strongly associated with poor prognosis in patients with esophageal cancer, especially those treated by chemoradiotherapy. Further investigation is warranted to explain this different prognosis.

Survival Rate and Prognostic Factors of Esophageal Cancer in East Azerbaijan Province, North-west of Iran

“…The other factor was cigarette smoking which inversely predicted the survival. This is consistent with several studies (Sundelof et al, 2008;Cescon et al, 2009;Shitara et al, 2010). Female patients had a tendency to a better survival rate during time, but this difference did not reach the significance.…”

“…This is reflected in the 1 and 3 year survival rates as well.Survival of esophageal cancer is influenced by several factors. Age of patients was one of the Predictive factors in the current study and was inversely associated with the survival rate, as in several studies (Hajian, 2001;Alidina et al, 2004;Shitara et al, 2010;Aghcheli et al, 2011;Ghadimi et al, 2011). The other factor was cigarette smoking which inversely predicted the survival.…”

“…Tumor stage is the most important prognostic factor for any type of cancer as the planning for optimal treatment is mainly decided accordingly (Nomura et al, 2012). The results of the current study showed that the five year survival rate of our study sample was lower in stages II and IV compared to Netherlands, China and Japan (Christian et al, 2007;Shitara et al, 2010;Nomura et al, 2012) while the rate was higher in stage III compared to Netherlands, China and Germany (Rades et al, 2006;Christian et al, 2007;Shitara et al, 2010). In Conclusion, prognosis of esophageal cancer in North West of Iran is poor, Therefore, reduce the exposure to risk factors and early detection can improve survival in such patients.…”

Impact of pre-diagnosis behavior on risk of death from esophageal cancer: a systematic review and meta-analysis

“…Three studies presented results for ESCC and EAC separately [13][14][15][16] and five for ESCC only [17][18][19][20][21]. The remaining four did not differentiate histological type.…”

“…The most commonly reported measures were never or ever [16,17,21,23] and never, former, or current [12][13][14][15]22], but nine different category systems were used. Four of the ten ESCC studies [13,[18][19][20] and one of four EAC studies [22] reported at least one smoking category with a statistically significantly increased hazard compared with the never or least smoking category. Figure 2 presents a forest plot of the HRs of pre-diagnosis smoking status (ever versus never, after collapsing categories where necessary) for ESCC and EAC.…”