TY - JOUR

T1 - The impact of tobacco smoking on survival of patients with oral squamous cell carcinoma

T2 - a population-based retrospective study

AU - Andersen, Amanda Oester

AU - Jensen, Jakob Schmidt

AU - Jakobsen, Kathrine Kronberg

AU - Stampe, Helene

AU - Nielsen, Kristoffer Juul

AU - Wessel, Irene

AU - Christensen, Anders

AU - Andersen, Elo

AU - Friborg, Jeppe

AU - Grønhøj, Christian

AU - von Buchwald, Christian

N1 - Publisher Copyright: © 2022 Acta Oncologica Foundation.

PY - 2022

Y1 - 2022

N2 - Background: This article aims to evaluate the impact of smoking status, accumulated tobacco exposure (ATE), and smoking cessation on overall- and disease-free survival (OS and DFS) of patients with oral squamous cell carcinoma (OSCC). Material and Methods: Patients with primary OSCC treated with curative intent between 2000 and 2019 in Copenhagen were included (n = 1808). Kaplan–Meier curves and multivariable Cox regression analyses were performed to compare the survival of patients with different smoking history. Interactions between ATE and (A) tumor subsite and (B) excessive alcohol consumption (EAC) on the survival were evaluated using multivariable Cox regression analyses with interaction terms. Results: We included 1717 patients with known smoking status (62.8% males, median age: 64 years (IQR: 57–71 years)), who had a 5-year OS of 53.7% (95%CI: 49.8%–57.9%). Based on fully adjusted multivariable Cox regression analyses, significantly elevated hazard ratios (HRs) for OS and DFS were identified for current, but not former smokers, compared to never-smokers. An approximately linear relationship between continuous ATE and survival estimates was identified. ATE analyzed as a categorical variable showed significantly elevated HRs for OS of patients with all categories (0 (Formula presented.) x (Formula presented.) 30, 30 (Formula presented.) x (Formula presented.) 60, and (Formula presented.) 60 PYs), however only for DFS of patients with >60 PYs, compared to 0 PYs. Furthermore, an unfavorable long-term prognosis was evident after >3.5 (OS) and >2.5 (DFS) years from diagnosis for patients who continued smoking compared to patients with smoking cessation at diagnosis. The survival estimates of patients with different tumor subsite and alcohol consumption differed with increasing ATE. Conclusion: Tobacco smoking (assessed as smoking status and ATE) was associated with inferior survival (OS and DFS) among patients with OSCC. Unfavorable long-term prognosis was significant for patients who continued smoking compared to patients with smoking cessation at diagnosis. The impact of ATE on survival of patients with OSCC may depend on the tumor subsite and/or alcohol consumption.

AB - Background: This article aims to evaluate the impact of smoking status, accumulated tobacco exposure (ATE), and smoking cessation on overall- and disease-free survival (OS and DFS) of patients with oral squamous cell carcinoma (OSCC). Material and Methods: Patients with primary OSCC treated with curative intent between 2000 and 2019 in Copenhagen were included (n = 1808). Kaplan–Meier curves and multivariable Cox regression analyses were performed to compare the survival of patients with different smoking history. Interactions between ATE and (A) tumor subsite and (B) excessive alcohol consumption (EAC) on the survival were evaluated using multivariable Cox regression analyses with interaction terms. Results: We included 1717 patients with known smoking status (62.8% males, median age: 64 years (IQR: 57–71 years)), who had a 5-year OS of 53.7% (95%CI: 49.8%–57.9%). Based on fully adjusted multivariable Cox regression analyses, significantly elevated hazard ratios (HRs) for OS and DFS were identified for current, but not former smokers, compared to never-smokers. An approximately linear relationship between continuous ATE and survival estimates was identified. ATE analyzed as a categorical variable showed significantly elevated HRs for OS of patients with all categories (0 (Formula presented.) x (Formula presented.) 30, 30 (Formula presented.) x (Formula presented.) 60, and (Formula presented.) 60 PYs), however only for DFS of patients with >60 PYs, compared to 0 PYs. Furthermore, an unfavorable long-term prognosis was evident after >3.5 (OS) and >2.5 (DFS) years from diagnosis for patients who continued smoking compared to patients with smoking cessation at diagnosis. The survival estimates of patients with different tumor subsite and alcohol consumption differed with increasing ATE. Conclusion: Tobacco smoking (assessed as smoking status and ATE) was associated with inferior survival (OS and DFS) among patients with OSCC. Unfavorable long-term prognosis was significant for patients who continued smoking compared to patients with smoking cessation at diagnosis. The impact of ATE on survival of patients with OSCC may depend on the tumor subsite and/or alcohol consumption.

KW - accumulated tobacco exposure

KW - Cox regression analyses

KW - Oral squamous cell carcinoma

KW - packyears

KW - restricted cubic spline

KW - tobacco smoking

U2 - 10.1080/0284186X.2022.2033830

DO - 10.1080/0284186X.2022.2033830

M3 - Journal article

C2 - 35114883

AN - SCOPUS:85124289319

VL - 61

SP - 449

EP - 458

JO - Acta Oncologica

JF - Acta Oncologica

SN - 1100-1704

IS - 4

ER -