The prognostic role of cigarette smoking in oral cavity and pharyngeal cancer survival

Abstract

Background The association between smoking and oral cavity and pharyngeal cancer (OPC) is well-documented. However, the role of smoking as a potential prognostic factor for OPC mortality remains unclear. In this population-based study, we analyze cancer-specific survival (CSS) outcomes among OPC patients by smoking status at diagnosis in the diverse state of Florida. Methods All primary OPC cases with known smoking status (N = 38,990) from the Florida Cancer Registry Data that were diagnosed between 2005–2018 were analyzed. Cox proportional regression was conducted to assess the variables effecting OPC survival, including age, race/ethnicity, sex, socioeconomic status, cancer stage, cancer location (oropharynx, tongue, tonsil, etc.), and treatment received with special focus given to smoking status (current, former, and never smoker). Results Of all OPC cases, less than a third (29.6%) occurred among never smokers. Ever smokers accounted for 70.4% of total cases but 77.7% of all OPC deaths. In a multivariable analysis, former and current smokers had 26% and 79% increased risk of OPC death respectively. This was after adjusting for potential confounders and when compared to never smokers (HR: 1.26, 95%CI: 1.21–1.31; HR: 1.79 95%CI: 1.72–1.86). When solely comparing current to former smokers in a multivariable analysis, current smokers were found to be 40% more like to die from OPC (HR: 1.40, 95%CI: 1.36–1.46). Conclusion Smoking was independently associated with increased risk of OPC mortality. Survival disparities by race/ethnicity, SES as well as insurance status still exist among OPC patients in Florida. Medical providers should promote and facilitate patient participation in cigarette smoking cessation programs targeting current smokers.