Radiotherapy of NPC
Smoking is a poor prognostic factor for male nasopharyngeal carcinoma treated with radiotherapy

https://doi.org/10.1016/j.radonc.2013.08.003Get rights and content

Abstract

Background and Purpose

To evaluate the effect of smoking on prognosis of male nasopharyngeal carcinoma by comparing the treatment outcomes between smokers and non-smokers.

Materials and Methods

A total of 2450 nasopharyngeal carcinoma patients were enrolled, including 1865 male patients. Matching was performed between smokers and non-smokers in male patients according to age, UICC clinical stage, T stage, N stage and treatment. Survival outcomes were compared using Kaplan–Meier analysis and Cox regression. Smoking index was calculated by multiplying cigarette packs per day and smoked time (year).

Results

In male patients, smokers had significantly lower 5-year overall survival (70.1% vs. 77.5%, P < 0.001) and locoregional recurrent free survival (76.8% vs.82.4%, P = 0.002) compared with non-smokers. Matched-pair analysis showed that smokers kept a high risk of death compared with non-smokers (HR = 2.316, P < 0.001). High degree of smoking index (>15 pack-years) had a poor effect on overall survival (HR = 1.225, P = 0.016). When smoking index was more than 45 and 60 pack-years, the risk for death increased to 1.498 and 1.899 fold compared with non-smokers (P = 0.040, 0.001), respectively.

Conclusions

Smoking was a poor prognostic factor for male nasopharyngeal carcinoma. The heavier the patients smoked, the poorer prognosis they suffered.

Section snippets

Patient populations

This work had been approved by the ethics committees of Sun Yat-Sen University Cancer Center (SYSUCC). The medical records of 2820 patients newly diagnosed with NPC without distant metastasis in SYSUCC from November of 2000 to December of 2004 were reviewed. All patients received radical radiotherapy and completed the prescribed course of treatment. The exclusion criteria included: (1) lost follow-up within 5 years from diagnosis, (2) lack of the record of smoking habits. A total of 2450

Demographics

The baseline characteristics of the whole patients, male patients and matched-pair male patients are listed in Table 1. Gender and age proportion were significantly different in total patients and male patients with P < 0.001. No statistically different distribution existed in matched-pair patients. Due to most pathological types of the whole patients were undifferentiated non-keratinizing carcinoma (86.7%), we did not list pathological types in the baseline table. The KPS was mostly 90 scores

Discussion

Our study showed that smoking poorly impacts the prognosis of male NPC patients treated by radiotherapy (HR = 2.316, P < 0.001; matched-pair analysis). Quitting could not change the survival outcomes if the patient had smoked ever. Quantity analysis showed that, for male patients, high degree of SI group had a 1.225 fold hazard ratio of death risk compared with low degree of SI group (P = 0.016). Further analysis indicated that the impact of smoking quantity on prognosis was mainly caused by heavy

Conflicts of interest and informed consent

The authors have declared no conflicts of interest. Informed consent was obtained.

Acknowledgement

This work was supported by the Hi-Tech Research and Development Program of China (Grant number 2006AA02Z4B4).

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    These authors contributed equally to this work.

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