Department of Otolaryngology-Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Department of Biostatistics and Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Otolaryngol Head Neck Surg. 2024 Feb;170(2):438-446. doi: 10.1002/ohn.567. Epub 2023 Oct 27.
To determine the effect of tobacco cessation following laryngeal cancer diagnosis on response to first-line therapy, laryngectomy-free survival, and overall survival in patients who were current smokers at the time of diagnosis.
Retrospective, case-control study.
OU Stephenson Cancer Center, National Cancer Institute-Designated Cancer Center.
We included 140 patients diagnosed with laryngeal squamous cell carcinoma, who were current smokers at the time of diagnosis, and were treated with first-line definitive radiation or chemo/radiation with the intent to cure. The association between patient characteristics and treatment response was assessed using the χ test and logistic regression analysis. Survival outcomes were analyzed using Kaplan-Meier methods and Cox proportional-hazards models.
Of the 140 current smokers, 61 patients (45%) quit smoking prior to treatment initiation. In adjusted logistic regression analysis, quitters had 3.7 times higher odds of achieving a complete response to first-line therapy than active smokers (odds ratio: 3.694 [1.575-8.661]; P = .003). In the adjusted Cox proportional-hazards model, quitters were 54% less likely to require salvage laryngectomy within 7 years of diagnosis than active smokers (hazard ratio: 0.456 [0.246-0.848]; P = .013). Quitters had a statistically significant increase in 7-year overall survival compared to active smokers (P = .02).
This is the first study to show that in newly diagnosed laryngeal cancer patients who are current smokers at the time of diagnosis, tobacco cessation significantly increases therapy response, laryngectomy-free survival, and overall survival. These data stress the importance of systematically incorporating tobacco cessation programs into laryngeal cancer treatment plans.
确定诊断为喉癌后戒烟对初治反应、无喉切除术生存和总生存的影响，这些患者在诊断时为当前吸烟者。
回顾性病例对照研究。
俄克拉荷马大学斯蒂芬森癌症中心，美国国立癌症研究所指定癌症中心。
我们纳入了 140 名诊断为喉鳞状细胞癌的患者，这些患者在诊断时为当前吸烟者，并接受了一线根治性放疗或化疗/放疗，旨在治愈。使用 χ 检验和逻辑回归分析评估患者特征与治疗反应之间的关系。使用 Kaplan-Meier 方法和 Cox 比例风险模型分析生存结果。
在 140 名当前吸烟者中，有 61 名（45%）在开始治疗前戒烟。在调整后的逻辑回归分析中，与吸烟者相比，戒烟者对一线治疗有完全反应的可能性高 3.7 倍（优势比：3.694[1.575-8.661]；P=0.003）。在调整后的 Cox 比例风险模型中，与吸烟者相比，戒烟者在诊断后 7 年内需要挽救性喉切除术的可能性低 54%（风险比：0.456[0.246-0.848]；P=0.013）。与吸烟者相比，戒烟者的 7 年总生存率有统计学意义的提高（P=0.02）。
这是第一项研究表明，在诊断为喉癌的当前吸烟者中，戒烟可显著提高治疗反应、无喉切除术生存和总生存。这些数据强调了将戒烟计划系统地纳入喉癌治疗计划的重要性。
