Download PDF
Laryngorhinootologie 2021; 100(10): 799-810
DOI: 10.1055/a-1509-8883
Originalarbeit

Rauchen und Komorbidität ohne Einfluss auf geplante Zieldosis der Radio(chemo)therapie

Smoking and co-morbidity – it’s impact on dose achievement in radio(chemo)therapy for HNSCC
Asita Fazel
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Elgar Susanne Quabius
2   Institut für Immunologie, Christian-Albrechts-Universität zu Kiel, Germany
,
Alexander Fabian
3   Klinik für Strahlentherapie, Christian-Albrechts-Universität zu Kiel, Germany
,
Thilo Schleicher
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Konstantin Kress
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Martin Laudien
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Karen Huber
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Arved Herzog
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Mireia Gonzales Donate
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
,
Markus Hoffmann
1   Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Rauchen verschlechtert die Prognose von Patienten mit HNSCC. Darüber hinaus ist Rauchen mit der Prävalenz von Ko- und Multimorbidität assoziiert, sodass angenommen wird, dass Rauchen nicht per se, sondern Ko-/Multimorbidität die Prognose durch mangelnde Compliance an die Therapie durch z. B. Dosisreduktion der geplanten Therapie verschlechtert. Allerdings sind die Daten zu diesem Thema, insbesondere für HNSCC, derzeit spärlich und widersprüchlich.

Patientenakten und Tumordokumentationen von 643 konsekutiven Fällen des Kopf-Hals-Tumorzentrums der Universitätsklinik Kiel wurden retrospektiv ausgewertet. Patientencharakteristiken und Rauchgewohnheiten wurden erfasst und mit Komorbiditäten und Behandlungsverlauf korreliert.

Die untersuchten 643 Patientenakten zeigen, dass 113 (17,6 %) Patient*innen nicht, 349 (54,3 %) aktiv und 180 (28 %) vormals geraucht haben. 315 (49 %) sind ausschließlich chirurgisch therapiert, 121 (18,8 %) mittels Chirurgie + adjuvanter Radio(chemo)therapie (RCT) und 72 (11,2 %) mittels Chirurgie + adjuvanter RT. 111 (17,3 %) erhielten eine primäre RCT und 24 (3,7 %) eine primäre RT. 131 (20,4 %) weisen Ko-/Multimorbidität auf und 512 (79,6 %) nicht. Rauchen (> 10 Pack Years) ist signifikant mit Komorbidität assoziiert (p = 0,002). Allerdings sind Rauchen und Komorbidität, weder allein noch in Kombination, mit dem Erreichen der Zieldosis der RCT korreliert (p > 0,05).

Wie erwartet, ist Rauchen signifikant mit Ko-/Multimorbidität verknüpft. Dosisreduktion der R(C)T ist bei aktiven Rauchern und Patienten mit Ko-/Multimorbidität ebenso häufig wie bei Nichtrauchern und Patienten ohne Ko-/Multimorbidität. Rauchen und Ko-/Multimorbidität beeinflussen demnach die Prognose auf andere Weise als durch Beeinträchtigung geplanter Therapieschemata.

Abstract

Smoking worsens the prognosis of patients with HNSCC. Furthermore, smoking is associated with the prevalence of co- and multimorbidity, so that it is assumed that not smoking per se, but co-/multimorbidity worsens the prognosis due to lack of compliance to therapy, e. g. by reducing the dose of the planned radio(chemo)therapy (RCT). However, data on this topic are currently sparse and contradictory, especially for HNSCC.

Patient records and tumor documentation of 643 consecutive cases of the Head and Neck Tumor Center of the University Hospital Kiel were retrospectively evaluated. Patient characteristics and smoking habits were recorded and correlated with co-/multimorbidity and treatment course.

The 643 patient files examined show that 113 (17.6 %) patients did not smoke, 349 (54.3 %) were active and 180 (28 %) patients had previously smoked. 315 (49 %) are treated exclusively by surgery; 121 (18.8 %) by surgery + adjuvant RCT and 72 (11.2 %) by surgery + adjuvant RT. 111 (17.3 %) receive a primary RCT and 24 (3.7 %) a primary RT. 131 (20.4 %) show co-/multimorbidity and 512 (79.6 %) do not. Smoking (> 10 py) is significantly associated with comorbidity (p = 0.002). However, smoking and comorbidity, neither alone nor in combination, are correlated with the achievement of the target dose of RCT (p > 0.05).

As expected, smoking is significantly linked to co-/multimorbidity. Dose reduction of R(C)T is just as frequent in active smokers and patients with co-/multimorbidity as in non-smokers and patients without co-/multimorbidity. Thus, smoking and co-/multimorbidity influence the prognosis in other ways than by interfering with planned therapy regimens.

Schlüsselwörter

Rauchen - Komorbidität - Therapie-Compliance - Dosisleistung - Radiochemotherapie - HNSCC

Key words

smoking - co-morbidity - therapy compliance - HNSCC - radiochemotherapy


Publication History

Received: 26 August 2020

Accepted: 23 October 2020

Article published online:
17 June 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Miller DL, Puricelli MD, Stack MS. Virology and molecular pathogenesis of HPV (human papillomavirus)-associated oropharyngeal squamous cell carcinoma. Biochem J 2012; 443: 339-353
    CrossrefPubMedGoogle Scholar
  • 2 Marty R, Roze S, Bresse X. et al. Estimating the clinical benefits of vaccinating boys and girls against HPV-related diseases in Europe. BMC Cancer 2013; 13: 10
    CrossrefPubMedGoogle Scholar
  • 3 Marur S, Forastier AA. Head and neck squamous cell carcinoma: update on epidemiology, diagnosis, and treatment. Mayo Clin Proc 2016; 91: 386-396
    CrossrefPubMedGoogle Scholar
  • 4 Ang KK, Harris J, Wheeler R. et al. Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 2010; 363: 24-35
    CrossrefPubMedGoogle Scholar
  • 5 Hoffmann M, Quabius ES, Tribius S. et al. Influence of HPV-status on survival of patients with tonsillarcarcinomas (TSCC) treated by CO2 surgery plus risk adapted therapy – a 10 year retrospective single centre study. Cancer Lett 2018; 413: 59-68
    CrossrefPubMedGoogle Scholar
  • 6 Anantharaman D, Abedi-Ardekani B, Beachler DC. et al. Geographic heterogeneity in the prevalence of humanpapillomavirus in head and neck cancer. Int J Cancer 2017; 140: 1968-1975
    CrossrefPubMedGoogle Scholar
  • 7 Fakhry C, Gillison ML. Clinical implications of human papillomavirus in head and neck cancers. J Clin Oncol 2006; 24: 2606-2611
    CrossrefPubMedGoogle Scholar
  • 8 Ahmadi N, Chan M, Huo YR. et al. Survival outcome of tonsillar squamous cell carcinoma (TSCC) in the context of humanpapillomavirus (HPV): a systematic review and meta-analysis. Surgeon 2019; 17: 6-14
    CrossrefPubMedGoogle Scholar
  • 9 Sharp L, McDevitt J, Carsin AE. et al. Smoking at diagnosis is an independent prognostic factor for cancer-specific survival in head and neck cancer: findings from a large, population-based study. Cancer Epidemiol Biomarkers Prev 2014; 23: 2579-2590
    CrossrefPubMedGoogle Scholar
  • 10 Bøje CR. Impact of comorbidity on treatment outcome in head and neck squamous cell carcinoma-a systematic review. Radiother Oncol 2014; 110: 81-90
    CrossrefPubMedGoogle Scholar
  • 11 Beynon RA, Lang S, Schimansky S. et al. Tobacco smoking and alcohol drinking at diagnosis of head and neck cancer all-cause mortality: results from head and neck 5000, a prospective observational cohort of people with head and neck cancer. Int J Cancer 2018; 143: 1114-1127
    CrossrefPubMedGoogle Scholar
  • 12 Peterson LA, Bellile EL, Wolf GT. et al. University of Michigan Head and Neck Specialized Program of Research Excellence Program. Cigarette use, comorbidities, and prognosis in prospective head and neck squamous cell carcinoma population. Head Neck 2016; 38: 1810-1820
    CrossrefPubMedGoogle Scholar
  • 13 McCarter K, Baker AL, Britton B. et al. Smoking, drinking, and depression: comorbidity in head and neck cancer patients undergoing radiotherapy. Cancer Med 2018; 7: 2382-2390
    CrossrefPubMedGoogle Scholar
  • 14 Haigentz Jr M, Suarez C, Strojan P. et al. Understanding interactions of smoking on prognosis of HPV-associated oropharyngeal cancers. Adv Ther 2018; 35: 255-260
    CrossrefPubMedGoogle Scholar
  • 15 Chen PC, Yang CC, Wu CJ. et al Factors predict prolonged wait time and longer duration of radiotherapy in patients with nasopharyngeal carcinoma: a multilevel analysis. PLoS ONE 2014; e109930 . doi:10.1371
    CrossrefPubMedGoogle Scholar
  • 16 Lee L, Cheung WY, Atkinson E. et al. Impact of comorbidity on chemotherapy use and outcomes in solid tumors: a systemic review. J Clin Oncol 2011; 29: 106-117
    CrossrefPubMedGoogle Scholar
  • 17 Bøje CR, Dalton SO, Grønberg TK. et al. The impact of comorbidity on outcome in 12 623 Danish head and neck cancer patients: a population based study from the DAHANCA database. Acta Oncol 2013; 52: 285-293
    CrossrefPubMedGoogle Scholar
  • 18 Charlson ME, Pompei P, Ales KL. et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-383
    CrossrefPubMedGoogle Scholar
  • 19 Quan H, Li B, Couris CM. et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173: 676-682
    CrossrefPubMedGoogle Scholar
  • 20 Skillington SA, Kallogjeri D, Lewis Jr JS. et al. Prognostic importance of comorbidity and the association between comorbidity and p16 in oropharyngeal squamous cell carcinoma. JAMA Otolaryngol Head Neck Surg 2016; 142: 568-575
    CrossrefPubMedGoogle Scholar
  • 21 Fakhry C, Westra WH, Wang SJ. et al. The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancer. Cancer 2017; 123: 1566-1575
    CrossrefPubMedGoogle Scholar
  • 22 Habbous S, Harland LT, La Delfa A. et al. Comorbidity and prognosis in head and neck cancers: differences by subsites, stage, and human papillomavirus status. Head Neck 2014; 36: 802-810
    CrossrefPubMedGoogle Scholar
  • 23 Mahul BA, Gress DM, Meyer VLR. et al., eds. AJCC Cancer Staging Manual. 8th ed. New York, NY: Springer; 2017
    Google Scholar
  • 24 Fazel A, Quabius ES. Gonzales-Donate. et al Alteration of smoking habits with diagnosis influences survival of HNSCC patients. Mol Clin Oncol [in press]
    Google Scholar
  • 25 Gourin CG, McAfee WJ, Neyman KM. et al. Effect of comorbidity on quality of life and treatment selection in patients with squamous cell carcinoma of the head and neck. Laryngoscope 2005; 115: 1371-1375
    CrossrefPubMedGoogle Scholar
  • 26 Aarstad HJ, Osterhus AA, Aarstad HH. et al. General health-related quality of life scores from head and neck squamous cell carcinoma patients obtained throughout the first year following diagnosis predicted up to 10-year overall survival. Eur Arch Otorhinolaryngol 2018; 257: 207-217
    CrossrefPubMedGoogle Scholar