However, such a classification does not fully account for the intensity and duration of tobacco exposure. These data will be instrumental in selecting the appropriate cohorts for potential treatment intensification or de-escalation.įrom an epidemiologic perspective, smoking status is frequently stratified into three groups of never, current, and former smokers. Thus, there is strong interest in examining the risk of tobacco use on long term survival and recurrence rates in HNSCC, particularly in combination with other established prognostic factors. All of these may also be associated with clinical outcomes of interest in HNSCC patients. Smoking is associated with lifestyle and health variables, such as alcohol use, BMI and comorbidities. This is best derived from prospective, structured smoking assessments to properly understand the potential role of smoking in risk stratification treatment models that include other prognostic factors.
It is essential to better define the association between tobacco use and HNSCC survival and oncologic outcomes. However, analyzing smoking history is complex ( 10- 12), and studies in lung squamous cell carcinoma have indicated that duration of smoking as well as time since quitting is associated with incidence ( 13) and survival ( 14- 16). Previous studies have shown that all-cause mortality is worse among survivors who continue to smoke compared to never smokers, but this same benefit is not seen when comparing patients who recently quit smoking to patients who continue to smoke after diagnosis ( 9). Tobacco is a strong risk factor for the development of HNSCC via documented cellular, molecular, and epigenetic effects ( 6- 8).
Patients with Human Papillomavirus positive (HPV(+)) oropharyngeal cancer on average have better prognoses, which led to recommendations to de-escalate aggressive treatment and limit toxicity for this group, particularly if they have a favorable smoking history ( 5). There are many established factors associated with higher rates of recurrence, including tumor site, stage, Human Papillomavirus status, and diet ( 4). Approximately 35- 55% of patients with head and neck squamous cell carcinoma (HNSCC) experience locoregional recurrence or distant metastasis within two years of initial diagnosis ( 1, 2) and are at high risk for developing a second primary ( 3).
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