Cigarette use, comorbidities, and prognosis in a prospective head and neck squamous cell carcinoma population

Head Neck. 2016 Dec;38(12):1810-1820. doi: 10.1002/hed.24515. Epub 2016 Jul 19.


Background: To better understand the associations between a history of tobacco use and survival outcomes, cigarette use was prospectively surveyed in 687 previously untreated patients with cancer of the oral cavity (n = 271), oropharynx (n = 257), larynx (n = 135), or hypopharynx (n = 24).

Methods: Kaplan-Meier and Cox models explored the associations of tobacco use intensity (packs/day), duration (years of use), and timing before diagnosis with overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS).

Results: Cigarette use duration, timing, and intensity were significant predictors for all outcomes in univariate analysis. Never smoking and pack-years were not significantly associated with outcomes after adjustment for prognostic factors, such as stage, comorbidities, and human papillomavirus (HPV) status, which were strongly associated with clinical outcomes.

Conclusion: The findings confirm the association between smoking history and survival and the importance of clinical variables in evaluating smoking as a prognostic factor. Timing, intensity, and duration of cigarette use should be considered with other prognostic factors when considering risk stratification for treatment planning. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1810-1820, 2016.

Keywords: comorbidities; duration; epidemiology; head and neck cancer; intensity; recurrence; survival; tobacco.

MeSH terms

  • Age Distribution
  • Carcinoma, Squamous Cell / epidemiology*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / therapy
  • Cause of Death*
  • Cigarette Smoking / adverse effects*
  • Cigarette Smoking / epidemiology*
  • Cohort Studies
  • Comorbidity
  • Disease-Free Survival
  • Female
  • Head and Neck Neoplasms / epidemiology*
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / therapy
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Prevalence
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Sex Distribution
  • Squamous Cell Carcinoma of Head and Neck
  • Survival Analysis