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Active Tobacco Smoking and Distant Metastasis in Patients with Oropharyngeal Cancer

Active Tobacco Smoking and Distant Metastasis in Patients with Oropharyngeal Cancer.

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Active Tobacco Smoking and Distant Metastasis in Patients with Oropharyngeal Cancer

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  1. Active Tobacco Smoking and Distant Metastasis in Patients with Oropharyngeal Cancer 1Harvard Radiation Oncology Program, Boston, MA; 2Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham & Women's Hospital, Boston, MA; 3Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA RESULTS Distant metastasis is the site of first relapse in approximately 1/3rd of patients with locally advanced oropharyngeal carcinoma, irrespective of human papillomavirus status. Yet the risk factors associated with distant metastasis are not well characterized. We sought to characterize the relationship between smoking status and distant metastasis. PURPOSE • 33% of the patients were non-smokers, 51% were former smokers, 16% were active smokers. • The cumulative lifetime tobacco • smoking in pack-years for the 121 patients with available data was 20 (range, 0 - 150). • OVERALL RESULTS: • Median follow-up of 52 months for all patients and 58 months for surviving patients • 10 (8%) of patients developed distant metastases after treatment at a median time of 9 months. • 4-year CI of distant metastasis was 8%. • 4-year rate of DMFS was 77%. • Local, regional, and distant recurrences as site of first relapse occurred in 4 (25%), 3 (19%), and 9 (56%) patients, respectively • Only active smoking, T4 tumor, and N2c - N3 disease were predictive of higher CI of DM; pack years not. • Active smoking was associated with increased CI of distant metastasis compared to non-active smoking (former and never-smokers) (31% vs. 4%, p < 0.001) and compared to former smoking (3%, p < 0.001). • Patients who were former smokers had similar CI of distant metastasis compared to never-smokers (3% v 5%) Sean M. McBride, MD 1, Nawal N. Ali BS 3, Danielle N. Margalit, MD MPH 2, Annie W. Chan, MD 3 MATERIALS & METHODS • Retrospective cohort study of 132 patients who underwent definitive chemo-radiation for Stage III - IVA/B oropharyngeal cancer and on whom we had prospectively collected information no tobacco smoking at the time of diagnosis. • Patients were considered active smokers if they smoked tobacco at the time of the diagnosis. Patients who quit smoking prior to their diagnosis were considered former smokers. • Endpoints:Cumulative Incidence (CI) of Distant Metastasis & Distant Metastasis Free Survival (DMFS) • Analysis:Kaplan Meier method to estimate CI and DMFS with log rank test for significance. Multivariate analysis was conducted using Cox regression analysis. • 4-yr DMFS for active vs non-active smokers was 49% vs 83%. • On multi-variate analysis, after adjusting for T and N classification, active smoking was the strongest predictor of distant metastasis (HR=11.35, p<0.001) CONCLUSIONS This study identified a strong association between active smoking and distant metastasis in patients with oropharyngeal cancer.

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