Alcoholism: Independent predictor of survival in patients with head and neck cancer
Alcoholism: Independent predictor of survival in patients with head and neck cancer
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DOI：
10.1093/jnci/88.8.542
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发表时间：
1996-04-17
影响因子：
10.3
通讯作者：
Davis, S
中科院分区：
文献类型：
--
作者：
Deleyiannis, FWB;Thomas, DB;Davis, S
背景：尽管人们认识到酒精中毒在头颈癌患者中的高发病率，但酒精中毒的预后重要性还没有得到充分的评估。之前的研究人员推测，酗酒患者的预后可能比非酗酒患者更差，因为癌症更晚期，酒精的免疫抑制作用，以及其他与酒精相关的疾病导致的死亡率增加。目的：这项以人群为基础的研究的目标是确定与头颈癌患者生存相关的酒精中毒的特征，并从酒精中毒的独立特征组合中开发酒精中毒严重程度分级系统。方法：这项前瞻性研究包括1983年9月1日至1987年2月28日期间在华盛顿州西部三县地区被诊断为口腔、口咽、下咽或喉癌的649名患者，该地区参与了美国国家癌症研究所的监测、流行病学和最终结果计划。关于终生饮酒、酗酒治疗、癌症诊断前戒酒以及与酒精相关的健康问题的细节都是在诊断时通过面谈来确定的。根据患者对密歇根酒精中毒筛查测试问题的回答，患者被分为非酒精者和酒精者。通过Logistic回归分析发现，酒精消费和滥用与5年生存率独立相关的指标，通过合并合并患者合并，创建了最终的复合变量，称为酒精严重程度阶段。COX比例风险回归分析估计酒精中毒严重程度各阶段5年内因特定死因死亡的相对危险度(RR)。结果：酗酒(RR=2.06；95%可信区间[CI]=1.43-2.98)和与酒精相关的全身性健康问题(如肝病、胰腺炎、震颤妄想或癫痫发作)史(RR=2.76；95%CI=1.69-4.49)与死亡风险增加有关，而禁酒(即确诊癌症前一年每周饮酒少于一杯)(RR=0.62；95%CI=0.39-0.97)与死亡风险降低相关。这些关联与年龄、肿瘤部位、解剖分期、组织病理学分级、吸烟和抗肿瘤治疗类型无关。处于酒精中毒最严重的两个阶段的患者不仅死于头颈部癌症的风险增加，而且死于心血管疾病、肺部疾病和其他与酒精有关的原因的风险也增加。结论：酒精滥用可以为头颈癌患者提供重要的预后信息，可以通过酒精消费、功能障碍、与酒精相关的健康问题或戒酒史来衡量。我们的结果表明，酗酒患者的戒酒可以延长生存时间。
Background: Despite recognition of the high prevalence of alcoholism among patients with head and neck cancer, the prognostic importance of alcoholism has not been evaluated adequately. Previous investigators have speculated that alcoholic patients may have a poorer prognosis than nonalcoholic because of more advanced stage of cancer, the immunosuppressive effects of alcohol, and an increased rate of death due to other alcohol-related diseases. Purpose: The goal of this population-based study was to identify the features of alcoholism that are associated with survival for patients with head and neck cancer and to develop an alcoholic severity staging system from a composite of the independent features of alcoholism. Methods: This prospective study included 649 patients who were diagnosed with cancer of the oral cavity, oropharynx, hypopharynx, or larynx during the period from September 1, 1983, through February 28, 1987, in a three-county area of western Washington state that participates in the Surveillance, Epidemiology, and End Results Program of the U.S. National Cancer Institute. Details on lifetime alcohol consumption, treatment for alcoholism, abstinence from alcohol prior to the diagnosis of cancer, and alcohol-related health problems were ascertained through in-person interviews near the time of diagnosis. Patients were classified as either nonalcoholics or alcoholics according to their responses to questions from the Michigan Alcoholism Screening Test. The measures of alcohol consumption and abuse that were found to be independently associated with 5-year survival by logistic regression analysis were combined using conjunctive con patients solidation to create a final composite variable, called an alcoholic severity stage. Cox proportional hazards regression analysis was done to estimate the relative risk (RR) of death within 5 years due to specific causes of death for each of the alcoholic severity stages. Results: Alcoholism (RR = 2.06; 95% confidence interval [CI] = 1.43-2.98) and a history of alcohol-related systemic health problems (i.e., liver disease, pancreatitis, delirium tremens, or seizures) (RR = 2.76; 95% CI = 1.69-4.49) were associated with an increased risk of death, whereas abstinence (i.e., the consumption of fewer than one drink per week at 1 year prior to the diagnosis of cancer) (RR = 0.62; 95% CI = 0.39-0.97) was associated with a decreased risk of death. These associations were independent of age, site of cancer, anatomical stage, histopathologic grade, smoking, and type of antineoplastic treatment. Patients in the two worst alcoholic severity stages had an increased risk of dying not only of head and neck cancer but also of cardiovascular disease, pulmonary disease, and other alcohol-related causes. Conclusions: Alcohol abuse, measured by alcohol consumption, functional impairment, a history of alcohol-related health problems, or abstinence, can provide important prognostic information for patients with head and neck cancer. Our results suggest that sobriety among alcoholic patients can lead to prolonged survival.