Prognostic Impact of Cigarette Smoking on the Survival of Patients with Established Nasopharyngeal Carcinoma

Abstract

Background: Cigarette smoking is associated with the etiology of nasopharyngeal carcinoma; however, the influence of smoking on survival in patients with established nasopharyngeal carcinoma remains unknown.Methods: We retrospectively analyzed 1,849 patients with nasopharyngeal carcinoma who were categorized as never, former, and current smokers. Cumulative effect of smoking was defined in terms of pack-years. Associations between cigarette exposure and survival were estimated by Cox proportional hazards model.Results: The risks of death, progression, locoregional relapse, and distant metastasis were significantly higher for former and current smokers (all P 0.002) than never smokers. Heavy smokers with high pack-years had HRs for death of 3.31 [95% confidence interval (CI), 2.58-4.26; P < 0.001], for progression of 2.53 (95% CI, 2.03-3.16; P < 0.001), and for distant metastasis of 2.65 (95% CI, 1.89-3.70; P < 0.001). Specifically, in the cohort of 495 patients treated with intensity-modulated radiotherapy/three-dimensional conformal radiotherapy, we obtained similarly significant results. All of the survival outcomes remained significant in multivariate analyses.Conclusions: Pretreatment cigarette smoking is an independent, poor prognostic factor for patients with nasopharyngeal carcinoma, which is associated with increased risk of death, progression, locoregional relapse, and distant metastasis, with the risk increasing with pack-years.Impact: It is clear that cigarette smoking not only promotes carcinogenesis in the normal nasopharyngeal epithelium, but also affects the survival of patients with nasopharyngeal carcinoma. Cancer Epidemiol Biomarkers Prev; 22(12); 2285-94. Ó2013 AACR.

Ten-year outcomes of a randomised trial for locoregionally advanced nasopharyngeal carcinoma: A single-institution experience from an endemic area

“…In addition to N-stage, age, gender and total radiotherapy doses, which are common prognostic factors in NPC [31], LDH, BMI and smoking are important baseline prognostic factors for tumour recurrence or distant metastasis. These findings are consistent with those presented in previous studies [13,14,32,33]. Currently, distant metastasis is the predominant pattern of failure in locoregionally advanced nasopharyngeal carcinoma [8].…”

“…BMI was defined as pre-treatment weight (kg) divided by the square of height (metres). Based on previous studies [13,14], smoking status at diagnosis was categorised into two groups: (i) never-smokers, which referred to patients who never smoked; and (ii) ex-smokers, which referred to former smokers who had stopped smoking and smokers who continued smoking until the day of hospitalisation. The cutoff values for Epstein-Barr virus (EBV) VCA-IgA and EA-IgA were set at 1:80 and 1:10, respectively, based on previous studies [15,16].…”

Diabetes, Prediabetes and the Survival of Nasopharyngeal Carcinoma: A Study of 5,860 Patients

“…As observed in our study, a higher percentage of diabetic patients were indeed smokers and overweight or obese. Additionally, according to recent studies, NPC patients with smoking history had poorer survival [32] whereas those with higher BMI had favorable survival [33] . Therefore, the contradictory effect of smoking and BMI maybe just right principally confounded the impact of FPG on survival of NPC.…”

Clinical features and prognostic factors in patients with head and neck cancer: Results from a multicentric study

“…One study reported that the effect of smoking was evident only among the chemoradiotherapy or radiotherapy group [37]; another, found that smoking status was the strongest predictor of survival, in both current and former smokers [38]; a third large population-based study from Ireland, involving 5652 patients with HNC, reported significantly increased cancer-related death rate for current smokers with oral cavity, pharyngeal, and laryngeal cancers, and the association was stronger in surgically treated patients [39]. Moreover, the association between cigarette smoking and survival has been demonstrated also in colon [40], pancreatic cancer [41], renal cell carcinoma [42], oropharyngeal [43], and nasopharyngeal carcinoma [44] highlighting a possible enduring effects of smoking, even after stopping. In our study, smoking status at diagnosis is not an independent prognostic factor of overall survival among patients with HNC.…”