Fazel Asita, Quabius Elgar Susanne, Gonzales-Donate Mireia, Laudien Martin, Herzog Arved, Kress Konstantin, Schleicher Thilo, Fabian Alexander, Huber Karen, Hoffmann Markus
Department of Otorhinolaryngology, Head and Neck Surgery, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany.
Institute of Immunology, Christian-Albrechts-University, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany.
Mol Clin Oncol. 2020 Nov;13(5):50. doi: 10.3892/mco.2020.2120. Epub 2020 Aug 20.
The impact of smoking on survival in patients with squamous cell carcinoma of the head and neck is well established, despite some conflicting data in the literature. However, data on alterations of smoking habit following cancer diagnosis is sparse. In the present study, the effect of reduction of smoking compared with cessation on the course of disease was studied. Data from 643 patients with HNSCC from the tumor documentation registry of the Department of Otorhinolaryngology, Head and Neck Surgery of the Christian-Albrechts-University Kiel were collected and statistically analyzed, looking at pre- and post-treatment smoking habit and survival. Alteration of smoking at the first diagnosis of HNSCC led to a significantly beneficial effect on survival outcomes compared with continued smoking, without significant differences between reduction and cessation of smoking. Detailed analysis revealed that this effect was solely dependent on patients treated by surgery only. Lifelong non-smokers exhibited a significant survival advantage compared with active and former smokers, with no difference in survival between these last two groups. The positive influence of altered smoking habit following first time diagnosis on disease-specific survival paralleled the negative direct effect of active smoking on therapy, which is predominantly attributed to peritumoral tissue hypoxia leading to impaired efficacy of radiochemotherapy (RCT). In the present study cohort, the positive effect of smoking habit alterations were primarily observed in patients treated by surgery only instead of RCT, possibly due to fewer perioperative complications. These findings indicated that patients should be encouraged to at least minimize smoking following cancer diagnosis. Furthermore, for survival estimates and therapy planning, former smokers should be considered as active smokers.
吸烟对头颈部鳞状细胞癌患者生存的影响已得到充分证实，尽管文献中有一些相互矛盾的数据。然而，关于癌症诊断后吸烟习惯改变的数据却很少。在本研究中，我们研究了与戒烟相比，减少吸烟对疾病进程的影响。收集了基尔基督教-阿尔布雷希茨大学耳鼻咽喉头颈外科肿瘤记录登记处643例头颈部鳞状细胞癌患者的数据，并对治疗前后的吸烟习惯和生存率进行了统计分析。与持续吸烟相比，头颈部鳞状细胞癌初次诊断时吸烟习惯的改变对生存结果有显著的有益影响，减少吸烟和戒烟之间没有显著差异。详细分析表明，这种影响仅取决于仅接受手术治疗的患者。终身不吸烟者与现吸烟者和既往吸烟者相比具有显著的生存优势，后两组之间的生存率没有差异。初次诊断后吸烟习惯改变对疾病特异性生存的积极影响与现吸烟对治疗的负面直接影响相似，这主要归因于肿瘤周围组织缺氧导致放化疗（RCT）疗效受损。在本研究队列中，吸烟习惯改变的积极影响主要在仅接受手术而非RCT治疗的患者中观察到，可能是由于围手术期并发症较少。这些发现表明，应鼓励患者在癌症诊断后至少尽量减少吸烟。此外，为了进行生存估计和治疗规划，既往吸烟者应被视为现吸烟者。
