Smoking, alcohol consumption predict poor head and neck cancer survival

Prediagnosis smoking served as a predictor of shorter OS among patients with oropharyngeal cancers, whereas alcohol consumption predicted shorter OS and cancer-specific survival among patients with laryngeal cancer, according to results of a pooled analysis.

“Squamous cell carcinoma of the head and neck is the seventh [most] common cancer worldwide, with approximately 600,000 new cases diagnosed each year worldwide,” Roberta Pastorino, PhD, of the institute of hygiene at Universita Cattolica del Sacro Cuore, and colleagues wrote. “The OS rate for these neoplasms has improved over the last decades, but still differs depending on the head and neck cancer subsite. To date, very few large studies have examined the role of prognostic factors for head and neck cancer on survival from these neoplasms.”

The researchers conducted a pooled analysis of five studies, including data of 4,759 patients with head and neck cancers. The researchers used Cox proportional hazard ratios to identify factors associated with survival.

For all head and neck cancer sites combined, 5-year OS was 51.4%, with 63.9% for larynx, 50.3% for oral cavity, 41.1% for oropharynx and 35% for hypopharynx. Five-year head and neck cancer-specific survival was 57.4% for all head and neck cancers, including 72.3% for larynx, 54.6% for oral cavity, 45.4% for oropharynx and 37.1% for hypopharynx.

Advanced tumor stage and older age at diagnosis were both unfavorable predictors of OS and cancer-specific survival.

Low level of education appeared to be an unfavorable predictor of OS in laryngeal cancer (HR = 2.54; 95% CI, 1.01-6.38, for high school or lower vs. college graduate).

The status and intensity of alcohol consumption appeared to be prognostic factors for both OS (current drinkers, HR = 1.73; 95% CI, 1.16-2.58) and cancer-specific survival (current drinkers, HR = 2.11; 95% CI, 1.22-3.66) in laryngeal cancer.

Smoking status served as a predictor of OS in patients who had oropharyngeal cancer. Smoking more than 20 cigarettes a day appeared as an independent prognostic factor for OS in cancer of the oral cavity (HR = 1.41; 95% CI, 1.03-1.92).

The researchers acknowledged they did not have information about comorbidities and lacked data about patient behavior after diagnosis, which may have limited the study.

“Our study showed that cigarette smoking was a prognostic factor of the OS for patients with cancer of the oral cavity and oropharynx, and alcohol drinking was a prognostic factor of the OS and head and neck cancer-specific survival for patients with cancer of the larynx,” the researchers wrote. “Additional studies including a large sample of patients that allow the adjustment for the main confounders, including comorbidities, and the lifestyle habits after the diagnosis might define and will highlight the differences of head and neck cancer subsites in terms of lifestyle-related prognostic factors.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.