The influence of smoking,age and stage at diagnosis on the survival after larynx,hypopharynx and oral cavity cancers in Europe: The ARCAGE study |
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| Authors: | Renata Abrahão Devasena Anantharaman Valérie Gaborieau Behnoush Abedi‐Ardekani Pagona Lagiou Areti Lagiou Wolfgang Ahrens Ivana Holcatova Jaroslav Betka Franco Merletti Lorenzo Richiardi Kristina Kjaerheim Diego Serraino Jerry Polesel Lorenzo Simonato Laia Alemany Antonio Agudo Trigueros Tatiana V. Macfarlane Gary J. Macfarlane Ariana Znaor Max Robinson Cristina Canova David I. Conway Sylvia Wright Claire M. Healy Mary Toner Gabriella Cadoni Stefania Boccia Tarik Gheit Massimo Tommasino Ghislaine Scelo Paul Brennan |
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| Affiliation: | 1. Genetic Epidemiology Group, International Agency for Research on Cancer, Lyon, France;2. Cancer Research Program, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India;3. Genetic Cancer Susceptibility Group, International Agency for Research on Cancer, Lyon, France;4. Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece;5. Department of Public Health and Community Health, School of Health Professions, Athens University of Applied Sciences, Athens, Greece;6. Leibniz Institute for Prevention Research and Epidemiology ‐ BIPS, Bremen, Germany;7. Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany;8. Institute of Hygiene and Epidemiology, 1st Faculty of Medicine, Charles University of Prague, Prage, Czech Republic;9. Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University of Prague, Prague, Czech Republic;10. Unit of Cancer Epidemiology, Department of Medical Sciences, University of Turin, Turin, Italy;11. Cancer Registry of Norway, Oslo, Norway;12. Unit of Cancer Epidemiology, Aviano National Cancer Institute, IRCCS, Aviano, Italy;13. Department of Cardiovascular and Thoracic Sciences, University of Padova, Padova, Italy;14. Institut Català d'Oncologia, IDIBELL, L'Hospitalet de Llobregat, Catalonia, Spain;15. CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;16. Epidemiology Group, University of Aberdeen, Aberdeen, United Kingdom;17. Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom;18. Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France;19. Center for Oral Health Research, Newcastle University, Newcastle‐upon‐Tyne, United Kingdom;20. Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy;21. School of Medicine, Dentistry, and Nursing, University of Glasgow, Glasgow, United Kingdom;22. Department of Pathology, Queen Elizabeth University Hospital, Glasgow, United Kingdom;23. Trinity College School of Dental Science, Dublin, Ireland;24. Institute of Othorinolaringoiatry, Università Cattolica del Sacro Cuore, Fondazione Policlinico ‘Agostino Gemelli’, Rome, Italy;25. Section of Hygiene ‐ Institute of Public Health, Università Cattolica del Sacro Cuore, Fondazione Policlinico ‘Agostino Gemelli’, Rome, Italy;26. Infections and Cancer Biology Group, International Agency for Research on Cancer, Lyon, France |
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| Abstract: | Head and neck cancer (HNC) is a preventable malignancy that continues to cause substantial morbidity and mortality worldwide. Using data from the ARCAGE and Rome studies, we investigated the main predictors of survival after larynx, hypopharynx and oral cavity (OC) cancers. We used the Kaplan–Meier method to estimate overall survival, and Cox proportional models to examine the relationship between survival and sociodemographic and clinical characteristics. 604 larynx, 146 hypopharynx and 460 OC cancer cases were included in this study. Over a median follow‐up time of 4.6 years, nearly 50% (n = 586) of patients died. Five‐year survival was 65% for larynx, 55% for OC and 35% for hypopharynx cancers. In a multivariable analysis, we observed an increased mortality risk among older (≥71 years) versus younger (≤50 years) patients with larynx/hypopharynx combined (LH) and OC cancers [HR = 1.61, 95% CI 1.09–2.38 (LH) and HR = 2.12, 95% CI 1.35–3.33 (OC)], current versus never smokers [HR = 2.67, 95% CI 1.40–5.08 (LH) and HR = 2.16, 95% CI 1.32–3.54 (OC)] and advanced versus early stage disease at diagnosis [IV versus I, HR = 2.60, 95% CI 1.78–3.79 (LH) and HR = 3.17, 95% CI 2.05–4.89 (OC)]. Survival was not associated with sex, alcohol consumption, education, oral health, p16 expression, presence of HPV infection or body mass index 2 years before cancer diagnosis. Despite advances in diagnosis and therapeutic modalities, survival after HNC remains low in Europe. In addition to the recognized prognostic effect of stage at diagnosis, smoking history and older age at diagnosis are important prognostic indicators for HNC. |
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| Keywords: | head and neck cancer predictors of survival ARCAGE study |
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