Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

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Abstract

Background

This study evaluated whether demographics, pre-diagnosis lifestyle habits and clinical data are associated with the overall survival (OS) and head and neck cancer (HNC)-specific survival in patients with HNC.

Patients and methods

We conducted a pooled analysis, including 4759 HNC patients from five studies within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. Cox proportional hazard ratios (HRs) and the corresponding 95% confidence intervals (CIs) were estimated including terms reported significantly associated with the survival in the univariate analysis.

Results

Five-year OS was 51.4% for all HNC sites combined: 50.3% for oral cavity, 41.1% for oropharynx, 35.0% for hypopharynx and 63.9% for larynx. When we considered HNC-specific survival, 5-year survival rates were 57.4% for all HNC combined: 54.6% for oral cavity, 45.4% for oropharynx, 37.1% for hypopharynx and 72.3% for larynx. Older ages at diagnosis and advanced tumour staging were unfavourable predictors of OS and HNC-specific survival. In laryngeal cancer, low educational level was an unfavourable prognostic factor for OS (HR = 2.54, 95% CI 1.01–6.38, for high school or lower versus college graduate), and status and intensity of alcohol drinking were prognostic factors both of the OS (current drinkers HR = 1.73, 95% CI 1.16–2.58) and HNC-specific survival (current drinkers HR = 2.11, 95% CI 1.22–3.66). In oropharyngeal cancer, smoking status was an independent prognostic factors for OS. Smoking intensity (>20 cigarettes/day HR = 1.41, 95% CI 1.03–1.92) was also an independent prognostic factor for OS in patients with cancer of the oral cavity.

Conclusions

OS and HNC-specific survival differ among HNC sites. Pre-diagnosis cigarette smoking is a prognostic factor of the OS for patients with cancer of the oral cavity and oropharynx, whereas pre-diagnosis alcohol drinking is a prognostic factor of OS and HNC-specific survival for patients with cancer of the larynx. Low educational level is an unfavourable prognostic factor for OS in laryngeal cancer patients.

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Most cited references 17

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Smoking and drinking in relation to oral and pharyngeal cancer.

W J Blot, J McLaughlin, D M Winn … (1988)

A case-control study of oral and pharyngeal cancer conducted in four areas of the United States provided information on the tobacco and alcohol use of 1114 patients and 1268 population-based controls. Because of the large study size, it could be shown that the risks of these cancers among nondrinkers increased with amount smoked, and conversely that the risks among nonsmokers increased with the level of alcohol intake. Among consumers of both products, risks of oropharyngeal cancer tended to combine more in a multiplicative than additive fashion and were increased more than 35-fold among those who consumed two or more packs of cigarettes and more than four alcoholic drinks/day. Cigarette, cigar, and pipe smoking were separately implicated, although it was shown for the first time that risk was not as high among male lifelong filter cigarette smokers. Cessation of smoking was associated with a sharply reduced risk of this cancer, with no excess detected among those having quit for 10 or more years, suggesting that smoking affects primarily a late stage in the process of oropharyngeal carcinogenesis. The risks varied by type of alcoholic beverage, being higher among those consuming hard liquor or beer than wine. The relative risk patterns were generally similar among whites and blacks, and among males and females, and showed little difference when oral and pharyngeal cancers were analyzed separately. From calculations of attributable risk, we estimate that tobacco smoking and alcohol drinking combine to account for approximately three-fourths of all oral and pharyngeal cancers in the United States.

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Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer.

Qiang Zhang, Weihong Xiao, Andy Trotti … (2012)

Tobacco smoking is associated with oropharynx cancer survival, but to what extent cancer progression or death increases with increasing tobacco exposure is unknown. Patients with oropharynx cancer enrolled onto a phase III trial of radiotherapy from 1991 to 1997 (Radiation Therapy Oncology Group [RTOG] 9003) or of chemoradiotherapy from 2002 to 2005 (RTOG 0129) were evaluated for tumor human papillomavirus status by a surrogate, p16 immunohistochemistry, and for tobacco exposure by a standardized questionnaire. Associations between tobacco exposure and overall survival (OS) and progression-free survival (PFS) were estimated by Cox proportional hazards models. Prevalence of p16-positive cancer was 39.5% among patients in RTOG 9003 and 68.0% in RTOG 0129. Median pack-years of tobacco smoking were lower among p16-positive than p16-negative patients in both trials (RTOG 9003: 29 v 45.9 pack-years; P = .02; RTOG 0129: 10 v 40 pack-years; P < .001). After adjustment for p16 and other factors, risk of progression (PFS) or death (OS) increased by 1% per pack-year (for both, hazard ratio [HR], 1.01; 95% CI, 1.00 to 1.01; P = .002) or 2% per year of smoking (for both, HR, 1.02; 95% CI, 1.01 to 1.03; P < .001) in both trials. In RTOG 9003, risk of death doubled (HR, 2.19; 95% CI, 1.46 to 3.28) among those who smoked during radiotherapy after accounting for pack-years and other factors, and risk of second primary tumors increased by 1.5% per pack-year (HR, 1.015; 95% CI, 1.005 to 1.026). Risk of oropharyngeal cancer progression and death increases directly as a function of tobacco exposure at diagnosis and during therapy and is independent of tumor p16 status and treatment.

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Pretreatment health behaviors predict survival among patients with head and neck squamous cell carcinoma.

Sonia A Duffy, David L Ronis, Scott McLean … (2009)

Our prior work has shown that the health behaviors of head and neck cancer patients are interrelated and are associated with quality of life; however, other than smoking, the relationship between health behaviors and survival is unclear. A prospective cohort study was conducted to determine the relationship between five pretreatment health behaviors (smoking, alcohol, diet, physical activity, and sleep) and all-cause survival among 504 head and neck cancer patients. Smoking status was the strongest predictor of survival, with both current smokers (hazard ratio [HR] = 2.4; 95% CI, 1.3 to 4.4) and former smokers (HR = 2.0; 95% CI, 1.2 to 3.5) showing significant associations with poor survival. Problem drinking was associated with survival in the univariate analysis (HR = 1.4; 95% CI, 1.0 to 2.0) but lost significance when controlling for other factors. Low fruit intake was negatively associated with survival in the univariate analysis only (HR = 1.6; 95% CI, 1.1 to 2.1), whereas vegetable intake was not significant in either univariate or multivariate analyses. Although physical activity was associated with survival in the univariate analysis (HR = 0.95; 95% CI, 0.93 to 0.97), it was not significant in the multivariate model. Sleep was not significantly associated with survival in either univariate or multivariate analysis. Control variables that were also independently associated with survival in the multivariate analysis were age, education, tumor site, cancer stage, and surgical treatment. Variation in selected pretreatment health behaviors (eg, smoking, fruit intake, and physical activity) in this population is associated with variation in survival.

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Author and article information

Journal

Journal ID (nlm-ta): Ann Oncol

Journal ID (iso-abbrev): Ann. Oncol

Journal ID (publisher-id): annonc

Title: Annals of Oncology

Publisher: Oxford University Press

ISSN (Print): 0923-7534

ISSN (Electronic): 1569-8041

Publication date (Print): November 2017

Publication date (Electronic): 30 August 2017

Publication date PMC-release: 30 August 2017

Volume: 28

Issue: 11

Pages: 2843-2851

Affiliations

[1 ]Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy;

[2 ]Public Health, Universidade de Sao Paulo, Sao Paulo, Brazil;

[3 ]Department of Head and Neck, Heliopolis Hospital, São Paulo, Brazil;

[4 ]Cancer Institute of the State of São Paulo, São Paulo, Brazil;

[5 ]Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy;

[6 ]Aichi Cancer Center Research Institute, Nagoya, Japan;

[7 ]Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy;

[8 ]Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;

[9 ]School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy;

[10 ]Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy;

[11 ]Department of Cardiologic, Vascular, Thoracic Sciences and Public Health of the University of Padova, Padova, Italy;

[12 ]Department of Molecular Medicine, University of Padua, Padua, Italy;

[13 ]Department of Medical Sciences, University of Turin, Turin, Italy;

[14 ]The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, NY, USA;

[15 ]Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA;

[16 ]Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah;

[17 ]Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA;

[18 ]Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico “A. Gemelli,” Rome, Italy;

Author notes

Correspondence to: Dr Roberta Pastorino, Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy. Tel: +39-6-30154396; E-mail: roberta.pastorino@ 123456unicatt.it

L. Giraldi and E. Leoncini contributed equally as senior authors

Author information

K Matsuo http://orcid.org/0000-0003-1761-6314

Article

Publisher ID: mdx486

DOI: 10.1093/annonc/mdx486

PMC ID: 5834132

PubMed ID: 28945835

SO-VID: fc6ac06b-b3d9-495c-a76b-30700e91d6ee

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

History

Page count

Pages: 9

Funding

Funded by: National Cancer Institute 10.13039/100000054

Award ID: R03CA113157

Funded by: National Institute of Dental and Craniofacial Research 10.13039/100000072

Alcohol and cigarette consumption predict mortality in patients with head and neck cancer: a pooled analysis within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium

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Abstract

Background

Patients and methods

Results

Conclusions

Related collections

Karger: Oncology

Most cited references 17

Smoking and drinking in relation to oral and pharyngeal cancer.

Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer.

Pretreatment health behaviors predict survival among patients with head and neck squamous cell carcinoma.

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