Impact of smoking status on clinical outcome in oral cavity cancer patients

Kawakita, Daisuke; Hosono, Satoyo; Ito, Hidemi; Oze, Isao; Watanabe, Miki; Hanai, Nobuhiro; Hasegawa, Yasuhisa; Tajima, Kazuo; Murakami, Shingo; Tanaka, Hideo; Matsuo, Keitaro

doi:10.1016/j.oraloncology.2011.09.012

Cited by 44 publications

(52 citation statements)

References 24 publications

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“…The pretreatment alcohol and cigarette intake data did vary in completeness; this might be considered relevant as some studies have demonstrated a dose-dependent relationship between pretreatment smoking and decreased OS [24]. However, for low-stage OCSCC, disease-specific mortality (DSM) is more relevant than OS and is very low in the present cohort.…”

Section: Resultsmentioning

confidence: 87%

Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma

Bai

Carroll

et al. 2012

Head and Neck Pathol

153

150

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The Risk Model is a validated outcome predictor for patients with head and neck squamous cell carcinoma (Brandwein-Gensler et al. in Am J Surg Pathol 20:167-178, 2005; Am J Surg Pathol 34:676-688, 2010 Head and Neck Pathol (2013) 7:211-223 DOI 10.1007/s12105-012-0412-1 in 9 T1N0 patients (6 %) and 9 T2N0 patients (10 %). On multivariable analysis, the Risk Model was significantly predictive of LRR (p = 0.0012, HR 2.41, 95 % CI 1.42, 4.11) and DSS (p = 0.0005, HR 9.16, 95 % CI 2.65, 31.66) adjusted for potential confounders. WPOI alone was also significantly predictive for LRR adjusted for potential confounders with a cut-point of either WPOI-4 (p = 0.0029, HR 3.63, 95 % CI 1.56, 8.47) or WPOI-5 (p = 0.0008, HR 2.55, 95 % CI 1.48, 4.41) and for DSS (cut point WPOI-5, p = 0.0001, HR 6.34, 95 % CI 2.50, 16.09). Given a WPOI-5, the probability of developing locoregional recurrence is 42 %. Given a high-risk classification for a combination of features other than WPOI-5, the probability of developing locoregional recurrence is 32 %. The Risk Model is the first validated model that is significantly predictive for the important niche group of low-stage OCSCC patients.

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Section: Resultsmentioning

confidence: 87%

Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma

Bai

Carroll

et al. 2012

Head and Neck Pathol

153

150

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“…Several studies in different head and neck sites have reported associations between smoking prediagnosis, or a history of tobacco use, and poorer survival/increased risk of death, sometimes (but not always) in a dose-dependent fashion (9)(10)(11)(12)(13). One study, which assessed exposure in terms of pack-years, suggested that the effect of light, moderate, or heavy smoking on survival was limited to patients who had radiotherapy or chemotherapy (14); another, in which smoking status was inferred from presence/absence of comorbid conditions, found that it was only present in those with human papilloma virus (HPV)-negative tumors (15); a third reported that smoking during radiotherapy was associated with an increased risk of death after adjusting for p16 status (16).…”

Section: Introductionmentioning

confidence: 99%

“…Some studies considered all-cause mortality (e.g., in refs. 11,14,16), which is influenced by the effects of smoking on risk of deaths from diseases other than cancer (20). Other studies failed to adjust the smoking-related risk estimates for other prognostic factors.…”

Section: Introductionmentioning

confidence: 99%

Smoking at Diagnosis Is an Independent Prognostic Factor for Cancer-Specific Survival in Head and Neck Cancer: Findings from a Large, Population-Based Study

Sharp

McDevitt

Carsin

et al. 2014

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Some studies suggest smoking may result in poorer clinical outcomes in head and neck cancer, but the evidence is heterogeneous and some of it is poor quality. In a large, population-based, study we investigated: (i) whether smoking at diagnosis is an independent prognostic factor for cancer-specific survival in head and neck cancer; and (ii) whether the association varies by site and treatment.Methods: Head and neck cancers (ICD10 C01-C14, and C30-32) diagnosed from 1994 to 2009 were abstracted from the National Cancer Registry Ireland, and classified by smoking status at diagnosis. Follow-up was for 5 years or until December 31, 2010. Multivariate Cox proportional hazards models were used to compare cancerspecific death rates in current, ex-, and never smokers. Subgroup analyses by site and treatment were conducted.Results: In total, 5,652 head and neck cancers were included. At diagnosis, 24% were never smokers, 20% exsmokers, and 56% current smokers. Compared with never smokers, current smokers had a significantly raised death rate from cancer [multivariate HR, 1.36; 95% confidence interval (CI), 1.21-1.53]. The association was similar after restriction to squamous cell tumors. A significantly increased cancer-related death rate was seen for current smokers with oral cavity, pharyngeal, and laryngeal cancers. The association was stronger in surgically treated patients [HR, 1.49; 95% CI, 1.25-1.79; P(interaction) ¼ 0.01]. Neither radiotherapy nor chemotherapy modified the effect of smoking.Conclusions: Patients with head and neck cancer who smoke at diagnosis have a significantly increased cancer death rate.Impact: Greater efforts are needed to encourage and support smoking cessation in those at risk of, and diagnosed with, head and neck cancer. Cancer Epidemiol Biomarkers Prev; 23(11); 2579-90. Ó2014 AACR.

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“…In another retrospective study of 151 patients with non-small cell lung cancer, patients who had stopped smoking at the time of initial consultation (prior to surgery and postoperative radiotherapy) had a signifi cantly better loco-regional control at 5 years (77% vs. 52%, p = 0.002) than patients who continued to smoke [22]. In the retrospective study of Kawakita et al of 222 patients with cancer of the oral cavity, non-smokers and light smokers (<30 pack years) had signifi cantly better 5-year overall survival rates than moderate (31-59 pack years) and heavy smokers (≥60 pack years) [24]. Th e adjusted hazard ratios for moderate and heavy smokers versus light smokers were 2.44 (1.07-5.57, p = 0.034) and 2.66 (0.97-7.33, p = 0.058).…”

Section: Erythropoietin Stimulating Agents (Esas)mentioning

confidence: 96%

“…Furthermore, the results of the previously mentioned studies and meta-analyses might have been infl uenced by the patients' smoking habit, as smoking during radiotherapy has been shown to impair tumour oxygenation. Th is has been shown in particular for non-small cell lung cancer and headand-neck cancer [7,[22][23][24]. In a retrospective study of 181 patients with non-small cell lung cancer, loco-regional control at 2 years was better in patients who did not smoke than in patients who did smoke during radiotherapy (58% vs. 41%, p < 0.001) [7].…”

Section: Erythropoietin Stimulating Agents (Esas)mentioning

confidence: 97%

Challenges of anemia correction during radiotherapy and chemoradiation

Rades

Schild

2012

memo

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Th e eff ect of radiotherapy depends on optimal tumour oxygenation, as tumour hypoxia impairs the production of radiation-induced cytotoxic free radicals resulting in less tumour cell kill. Th e range of haemoglobin levels optimal for tumour oxygenation is 12-14 g/dl in women and 13-15 g/dl in men. It appears reasonable to elevate the haemoglobin level in anaemic cancer patients into this optimal range. Th is may be achieved with red blood cell transfusions (RBCT) or erythropoiesis stimulating agents (ESAs). However, RBCT have had negligible or even negative eff ect on patient outcome, possibly because RBCT induce immunosuppression or result in haemoglobin levels too high for optimal tumour oxygenation. Several randomized trials have demonstrated that patients irradiated for head-and-neck cancer had worse outcomes with ESAs than the control group. However, in the majority of these trials, over-treatment with ESAs resulted in haemoglobin levels above the optimal range. Tumour oxygenation is impaired by inappropriately high haemoglobin levels due to increased blood viscosity and decreased tumour cell perfusion. Th is concept is supported by the fi ndings of prospective studies in cervix cancer and esophageal cancer patients. In these studies the ESA administration was withheld at a haemoglobin level of 14 g/dl resulting in a positive eff ect of ESAs on treatment outcome. In summary, the eff ect of RBCT and particularly of ESAs during radiotherapy remains unclear. Further randomized trials are required. Until such trials are available, one should follow the ASCO and ESMO guidelines that are very conservative regarding the administration of ESAs during radiotherapy and chemoradiation.

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Impact of smoking status on clinical outcome in oral cavity cancer patients

Cited by 44 publications

References 24 publications

Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma

Validation of the Risk Model: High-Risk Classification and Tumor Pattern of Invasion Predict Outcome for Patients with Low-Stage Oral Cavity Squamous Cell Carcinoma

Smoking at Diagnosis Is an Independent Prognostic Factor for Cancer-Specific Survival in Head and Neck Cancer: Findings from a Large, Population-Based Study

Challenges of anemia correction during radiotherapy and chemoradiation

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