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

L Giraldi; E Leoncini; R Pastorino; V Wünsch-Filho; M de Carvalho; R Lopez; G Cadoni; D Arzani; L Petrelli; K Matsuo; C Bosetti; C La Vecchia; W Garavello; J Polesel; D Serraino; L Simonato; C Canova; L Richiardi; P Boffetta; M Hashibe; Y C A Lee; S Boccia

doi:10.1093/annonc/mdx486

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

Ann Oncol. 2017 Nov 1;28(11):2843-2851. doi: 10.1093/annonc/mdx486.

Authors

L Giraldi¹, E Leoncini¹, R Pastorino², V Wünsch-Filho³, M de Carvalho⁴, R Lopez⁵, G Cadoni⁶, D Arzani¹, L Petrelli⁶, K Matsuo⁷, C Bosetti⁸, C La Vecchia⁹, W Garavello¹⁰, J Polesel¹¹, D Serraino¹¹, L Simonato¹², C Canova¹³, L Richiardi¹⁴, P Boffetta¹⁵, M Hashibe¹⁶, Y C A Lee¹⁷, S Boccia¹⁸

Affiliations

¹ Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
² Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: roberta.pastorino@unicatt.it.
³ Public Health, Universidade de Sao Paulo, Sao Paulo, Brazil.
⁴ Department of Head and Neck, Heliopolis Hospital, São Paulo, Brazil.
⁵ Cancer Institute of the State of São Paulo, São Paulo, Brazil.
⁶ Institute of Otorhinolaryngology, Università Cattolica del Sacro Cuore, Rome, Italy.
⁷ Aichi Cancer Center Research Institute, Nagoya, Japan.
⁸ Department of Epidemiology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
⁹ Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
¹⁰ School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
¹¹ Unit of Cancer Epidemiology, CRO Aviano National Cancer Institute, Aviano, Italy.
¹² Department of Cardiologic, Vascular, Thoracic Sciences and Public Health of the University of Padova, Padova, Italy.
¹³ Department of Molecular Medicine, University of Padua, Padua, Italy.
¹⁴ Department of Medical Sciences, University of Turin, Turin, Italy.
¹⁵ The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, NY, USA; 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; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA.
¹⁷ Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
¹⁸ Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico "A. Gemelli," Rome, Italy.

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.

Keywords: epidemiology; head and neck cancer; pooled analysis; prognostic factors.

MeSH terms

Alcohol Drinking / adverse effects
Alcohol Drinking / mortality*
Female
Follow-Up Studies
Head and Neck Neoplasms / etiology
Head and Neck Neoplasms / mortality*
Humans
International Agencies
Male
Meta-Analysis as Topic
Middle Aged
Prognosis
Risk Factors
Smoking / adverse effects
Smoking / mortality*
Survival Rate