Does smoking influence survival in cancer patients through effects on respiratory and vascular disease?

Long-term survival trend after primary total laryngectomy for patients with locally advanced laryngeal carcinoma

Purpose: To evaluate long-term survival trends after primary total laryngectomy (TL) for locally advanced laryngeal carcinoma (LC). Methods: A total of 2094 patients diagnosed with locally advanced LC and underwent primary TL (1992-2011, at least 5-year follow-up) in the Surveillance, Epidemiology, and End Results (SEER) database were included in this study. Besides the traditional overall survival (OS) and cancer-specific survival (CSS) by using Kaplan-Meier curves, the 3-year conditional survival analysis was also performed to describe the long-term trends in these patients. Time-dependent multivariate competing-risk models were constructed to assess the persistent sub-distribution hazard of prognostic factors. Finally, a nomogram was developed to predict conditional cancer-specific survival. Results: The curves of overall hazard and cancer-specific hazard both quickly reached the apex within the first year since TL, then decreased thereafter. In general, the CS3 steadily increased from within 5 years after TL. In the stratified CS3 analysis, the increments in patients with adverse characteristics were more pronounced. 4 years after TL, the probability of surviving the next year exceeded 90%. The time-dependent multivariate competing-risk models indicated that age and lymph node ratio (LNR) persistently contributed to the cancer-specific outcome. The nomogram based on the competing-risk model was constructed to estimate CSS probability conditional upon 3 years for advanced LC patients having survived 1, 2, and 3 years. Conclusion: Most patients achieved a substantially improved survival rate after surviving a long period after primary TL. Patients diagnosed at older age and with higher LNR should receive more effective follow-up. The predictive nomogram can provide significant evidence for clinical research and practice.

Proton vs photon: A model-based approach to patient selection for reduction of cardiac toxicity in locally advanced lung cancer

PURPOSE/OBJECTIVE

To use a model-based approach to identify a sub-group of patients with locally advanced lung cancer who would benefit from proton therapy compared to photon therapy for reduction of cardiac toxicity.

MATERIAL/METHODS

Volumetric modulated arc photon therapy (VMAT) and robust-optimised intensity modulated proton therapy (IMPT) plans were generated for twenty patients with locally advanced lung cancer to give a dose of 70 Gy (relative biological effectiveness (RBE)) in 35 fractions. Cases were selected to represent a range of anatomical locations of disease. Contouring, treatment planning and organs-at-risk constraints followed RTOG-1308 protocol. Whole heart and ub-structure doses were compared. Risk estimates of grade⩾3 cardiac toxicity were calculated based on normal tissue complication probability (NTCP) models which incorporated dose metrics and patients baseline risk-factors (pre-existing heart disease (HD)).

RESULTS

There was no statistically significant difference in target coverage between VMAT and IMPT. IMPT delivered lower doses to the heart and cardiac substructures (mean, heart V5 and V30, P < .05). In VMAT plans, there were statistically significant positive correlations between heart dose and the thoracic vertebral level that corresponded to the most inferior limit of the disease. The median level at which the superior aspect of the heart contour began was the T7 vertebrae. There was a statistically significant difference in dose (mean, V5 and V30) to the heart and all substructures (except mean dose to left coronary artery and V30 to sino-atrial node) when disease overlapped with or was inferior to the T7 vertebrae. In the presence of pre-existing HD and disease overlapping with or inferior to the T7 vertebrae, the mean estimated relative risk reduction of grade⩾3 toxicities was 24-59%.

CONCLUSION

IMPT is expected to reduce cardiac toxicity compared to VMAT by reducing dose to the heart and substructures. Patients with both pre-existing heart disease and tumour and nodal spread overlapping with or inferior to the T7 vertebrae are likely to benefit most from proton over photon therapy.

The primary tumor resection in patients with distant metastatic laryngeal carcinoma

BACKGROUND

The role of primary tumor resection in patients with distant metastatic laryngeal carcinoma (DMLC) has not been clarified completely. Thus, we used propensity score matching (PSM) and survival analysis to address this issue.

METHODS

The PSM was utilized to avoid selection bias and disproportionate distributions of the confounding factors. Kaplan-Meier estimates and Cox proportional hazard analysis were utilized to evaluate overall survival (OS) and cancer-specific survival (CSS).

RESULTS

From the Surveillance, Epidemiology, and End Results Program database, a cohort of 480 patients with DMLC were included. After PSM, the OS and CSS for patients who underwent resection were significantly longer than those without resection (median OS: 19 months vs. 8 months, P < 0.001; median CSS: 19 months vs. 9 months, P = 0.002). Tumor resection significantly prolonged survival of DMLC patients with appropriate demographic and clinical characteristics. In the multivariate analysis, age at diagnosis, race, pathologic subtype, and marital status were found significantly affecting both OS and CSS of patients who underwent surgical resection. Predictive nomograms were developed to help distinguish patients with early mortality potential after surgical resection.

CONCLUSIONS

This study is the first one using PSM to assess the role played by surgical resection in DMLC and evaluate the prognostic factor of resected patients. Premised on well controlled postoperative complications, resection could significantly prolong OS and CSS of certain patients.

Smoking cessation and survival in lung, upper aero-digestive tract and bladder cancer: cohort study

BACKGROUND

The aim was to examine the association between smoking cessation and prognosis in smoking-related cancer as it is unclear that cessation reduces mortality.

METHODS

In this retrospective cohort study from 1999 to 2013, we assessed the association between cessation during the first year after diagnosis and all-cause and cancer-specific mortality.

RESULTS

Of 2882 lung, 757 upper aero-digestive tract (UAT) and 1733 bladder cancer patients 27%, 29% and 21% of lung, UAT and bladder cancer patients quit smoking. In lung cancer patients that quit, all-cause mortality was significantly lower (HR: 0.82 (0.74-0.92), while cancer-specific mortality (HR: 0.89 (0.76-1.04) and death due to index cancer (HR: 0.90 (0.77-1.05) were non-significantly lower. In UAT cancer, all-cause mortality (HR: 0.81 (0.58-1.14), cancer-specific mortality (HR: 0.84 (0.48-1.45), and death due to index cancer (HR: 0.75 (0.42-1.34) were non-significantly lower. There was no evidence of an association between quitting and mortality in bladder cancer. The HRs were 1.02 (0.81-1.30) for all-cause, 1.23 (0.81-1.86) for cancer specific, and 1.25 (0.71-2.20) for death due to index cancer. These showed a non-significantly lower risk in sensitivity analyses.

CONCLUSIONS

People with lung and possibly UAT cancer who quit smoking have a lower risk of mortality than people who continue smoking.

Reduced coenzyme Q(10) in female smokers and its association with lipid profile in a young healthy adult population

INTRODUCTION

Cigarette smoking has a negative effect on body reserve of antioxidants and cholesterol metabolism. Coenzyme Q(10) (CoQ(10)), a potent antioxidant synthesized as part of the cholesterol pathway, is a potential biomarker for systemic oxidative stress. We aimed to investigate gender variation in plasma lipid profile and CoQ(10) concentrations in healthy non-smokers and in smokers.

MATERIAL AND METHODS

The study included 55 cigarette smokers (25 females and 30 males) and 51 non-smokers (25 females and 26 males) with the age range from 21 to 45 years, and who had no history of alcohol abuse or chronic diseases such as diabetes mellitus or obesity. Coenzyme Q(10) plasma concentrations were measured by reverse-phase high performance liquid chromatography (HPLC) with ultraviolet detection. Fasting plasma glucose and lipid levels were determined by standard colorimetric methods.

RESULTS

Our results showed that CoQ(10) concentrations were significantly decreased in smokers, especially in females, than their non-smoker counterparts. Female smokers also exhibited a significant decrease in plasma concentrations of total cholesterol (TC), HDL-C, LDL-C, and atherogenic ratios HDL-C/TC and CoQ(10)/LDL-C than male counterparts. Plasma triglyceride concentrations were increased in smokers irrespective of gender. Plasma CoQ(10) was relatively more associated with TC and LDL-C in female smokers than male smokers.

CONCLUSIONS

The adverse effects of smoking on body reserve of antioxidants and cholesterol metabolism are greater in females than in males, partially as a result of decreased CoQ(10) plasma concentrations, HDL-C and total-cholesterol and abnormal atherogenicity indices.

Clinical Relevance of Conditional Survival of Cancer Patients in Europe: Age-Specific Analyses of 13 Cancers

Purpose

When cancer survivors wish to receive accurate information on their current prognosis during follow-up, conditional 5-year relative survival may be most suitable. We have estimated conditional 5-year relative survival for 13 cancers using a large European database—European Network for Indicators on Cancer (EUNICE)—of 10 dedicated long-standing cancer registries across Europe.

Patients and Methods

Patients age 15 years and older diagnosed between 1985 and 2004 were included. Conditional 5-year relative survival for each age group was computed for every additional year survived up to 10 years. Period analysis with follow-up period 2000 to 2004 was used.

Results

All patients with cutaneous melanoma or colorectal, endometrial, or testis cancer and younger patients with stomach, glottis, cervix, ovary, or thyroid cancer or non-Hodgkin's lymphoma exhibited hardly any excess mortality (conditional 5-year relative survival > 95%) given that they were alive at a defined time point within 10 years of initial diagnosis. However, patients with supraglottis, lung, breast, and kidney cancer, as well as older patients with most cancers exhibited substantial excess mortality (conditional 5-year relative survival < 90%). Initial differences in relative survival at diagnosis between age groups largely disappeared with time since initial diagnosis for melanoma, or stomach, colorectal, corpus uteri, or testicular cancer but persisted for patients diagnosed with other tumors. Differences between stage groups became smaller over time or disappeared.

Conclusion

Conditional relative survival shows clinically relevant variations according to time since diagnosis, type of cancer, and age, and can help serve as a guide for cancer survivors in planning for their future and for doctors in planning schedules for surveillance.

Disparities in smoking and cessation status among cancer survivors and non-cancer individuals: a population-based study from National Health and Nutrition Examination Survey

INTRODUCTION

Continued smoking after a cancer diagnosis is a critical problem. This study examined smoking prevalence among all and specific cancer survivors, and compared demographic profiles of the current smokers between cancer and non-cancer individuals.

METHODS

We used data from 2,188 cancer survivors and 22,441 non-cancer individuals who participated in the 10-year National Health and Nutrition Examination Survey (NHANES 1999-2008). All analyses were weighted to represent the United States population.

RESULTS

The current smoking rates decreased as age increased in both cancer and non-cancer populations. The smoking rate was higher in young cancer survivors (age <=40) than in young non-cancer individuals. The cervical, colon cancer and melanoma survivors had higher age-adjusted smoking rates than survivors of other cancers. For non-cancer individuals, the results showed that poorer white males with lower educational levels, with widowed, divorced, or separated marital status, who were underweight and had at least 12 alcoholic beverages a year, were more likely to be current smokers.

DISCUSSIONS/CONCLUSIONS

We can observe that age, race, education, marital status, and year since cancer diagnosis were important predictors of smoking status in cancer survivors based on the results of multivariable modeling and comparisons of age-adjusted smoking rates in specific cancer sub-groups. This implies that developing smoking cessation programs for cervical cancer and melanoma is of particularly high priority because survivors of these cancers had relatively high smoking rates and low quit smoking rates after diagnosis. These efforts should improve their quality of life and health status as well as reduce smoking-related health disparities.

Influence of inflammatory polyarthritis on cancer incidence and survival: Results from a community-based prospective study

OBJECTIVE

To investigate whether the incidence of cancer is increased and whether the rate of cancer survival is reduced in patients following the onset of inflammatory polyarthritis.

METHODS

Between 1990 and 1999, we recruited 2,105 patients to a large primary care-based register of new-onset inflammatory polyarthritis. Subsequent cancers were ascertained by linkage to hospital and death records and were confirmed by the regional cancer register. Cancer incidence, both all-site and site-specific, was compared with regional rates, adjusting for age, sex, and calendar year. Overall cancer survival, adjusted for site, was compared with regional data using Kaplan-Meier curves and Cox regression.

RESULTS

There were 123 incident cases of cancer in the cohort of patients with inflammatory polyarthritis. The overall incidence of cancer among this cohort of patients with inflammatory polyarthritis was not increased compared with that in the regional population. Among cancers of all major organ systems, only the incidence of hematopoietic cancers (including lymphoma) was increased. Five-year cancer survival was reduced in patients with inflammatory polyarthritis compared with patients without inflammatory polyarthritis. After adjusting for diagnosis, age, sex, and tumor type, mortality in patients with inflammatory polyarthritis and cancer was significantly increased (hazard ratio 1.4, 95% confidence interval 1.1-1.7).

CONCLUSION

This is the first investigation of overall cancer survival in patients with inflammatory polyarthritis. Compared with an increased incidence of cancer, reduced cancer survival might be a greater contributor to the increased cancer mortality observed in some rheumatoid arthritis populations.