8个吸烟指标在头颈部鳞状细胞癌患者生存模型中的表现。

IF 6 1区 医学 Q1 OTORHINOLARYNGOLOGY
Andrew C L Lam, Katrina Hueniken, Martha Pienkowski, John J W Lee, Mei Dong, Brenda Diergaarde, Andrew F Olshan, Paul Brennan, Shama Virani, Deborah Saunders, Stacey A Santi, Michael S C Conlon, Tim Waterboer, D Neil Hayes, Miranda Pring, Gary J Macfarlane, Pagona Lagiou, Areti Lagiou, Jerry Polesel, Antonio Agudo, Laia Alemany, Wolfgang Ahrens, Claire M Healy, David I Conway, Mari Nygard, Cristina Canova, Anna Hornakova, Lorenzo Richiardi, Ariana Znaor, Rayjean J Hung, Wei Xu, Geoffrey Liu
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引用次数: 0

摘要

重要性:吸烟是头颈部鳞状细胞癌(HNSCC)患者死亡的一个重要危险因素。然而,很少有证据支持哪种吸烟指标能最好地模拟吸烟与HNSCC患者生存之间的关系。目的:确定哪种吸烟指标最能模拟HNSCC患者吸烟暴露与总生存期(OS)之间的线性关系。设计、环境和参与者:对6项临床流行病学研究进行回顾性多中心队列研究。其中5人是人类乳头瘤病毒、口腔和口咽癌基因组研究(VOYAGER)联盟的成员。参与者包括18岁及以上病理证实的HNSCC患者。数据收集时间为2002年1月至2019年12月,分析时间为2022年1月至2024年11月。主要观察指标:主要观察指标为OS。比较了8个吸烟指标的表现,包括包年、持续时间和对数烟年(以log10[每天吸烟的卷数+ 1]×吸烟年数计算)用于建模OS。度量绩效以Cox比例风险模型的关联强度、线性趋势以P为基础、Akaike信息准则(AIC;值越低表示模型拟合越好),以及样条曲线的视觉评价。次要结果包括临床人口学亚组和HNSCC解剖亚位点的OS建模。探索性结果包括癌症特异性生存和非癌症生存。结果:共8875例HNSCC患者(2114例[24%]女性;中位[IQR]年龄61[54-69]岁)。在评估的8个吸烟指标中,吸烟持续时间(调整风险比[aHR], 1.11 [95% CI, 1.03-1.19])和对数g年(aHR, 1.11 [95% CI, 1.04-1.18])的aHR最高;两者与OS有统计学上显著的线性相关。对OS进行建模时,Log g-year的AIC线性值最低,样条曲线最直观。无论年龄、吸烟状况和癌症分期如何,持续时间和log - g-year在建模OS方面优于pack-year。两者在唇部、口腔、喉部(仅持续时间显著)和人乳头瘤病毒阴性的口咽亚位均表现良好。在一项探索性分析中,在建模非癌症生存时,病程具有最高的aHR (1.15 [95% CI, 1.02-1.29]), log g-years具有最低的AIC线性值。结论和相关性:在这项队列研究中,吸烟持续时间和log g-year与HNSCC患者OS的线性关系最好。这两个指标在特定的临床人口学亚组和解剖学亚位中都保持了良好的表现。尽管大多数HNSCC生存模型使用吸烟状态或包年来控制吸烟暴露,但持续时间和对数年可能是解释吸烟对生存影响的更好指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Performance of 8 Smoking Metrics for Modeling Survival in Head and Neck Squamous Cell Carcinoma.

Importance: Cigarette smoking is a strong risk factor for mortality in patients diagnosed with head and neck squamous cell carcinoma (HNSCC). However, little evidence supports which smoking metric best models the association between smoking and survival in HNSCC.

Objective: To determine which smoking metric best models a linear association between smoking exposure and overall survival (OS) in patients with HNSCC.

Design, setting, and participants: A retrospective multicenter cohort study of 6 clinical epidemiological studies was performed. Five were part of the Human Papillomavirus, Oral and Oropharyngeal Cancer Genomic Research (VOYAGER) consortium. Participants included patients 18 years and older with pathologically confirmed HNSCC. Data were collected from January 2002 to December 2019, and data were analyzed between January 2022 to November 2024.

Main outcomes and measures: The primary outcome was OS. The performance of 8 smoking metrics, including pack-years, duration, and log cig-years (calculated as log10[cigarettes smoked per day + 1] × number of years smoked) for modeling OS were compared. Metric performance was measured by the strength of association in Cox proportional hazard models, linearity based on P for linear trend, Akaike information criterion (AIC; lower value indicates better model fit), and visual assessment of spline curves. Secondary outcomes included modeling OS in clinicodemographic subgroups and HNSCC anatomic subsites. Exploratory outcomes included cancer-specific survival and noncancer survival.

Results: In total, 8875 patients with HNSCC (2114 [24%] female; median [IQR] age, 61 [54-69] years) were included. Of 8 smoking metrics evaluated, smoking duration (adjusted hazard ratio [aHR], 1.11 [95% CI, 1.03-1.19]) and log cig-years (aHR, 1.11 [95% CI, 1.04-1.18]) had the highest aHRs; both had a statistically significant linear association with OS. Log cig-years had the lowest AIC linear value and the most visually linear spline curve when modeling OS. Duration and log cig-years outperformed pack-years for modeling OS regardless of age, smoking status, and cancer stage. Both performed well in lip and oral cavity, laryngeal (only duration was significant), and human papillomavirus-negative oropharyngeal subsites. In an exploratory analysis, duration had the highest aHR (1.15 [95% CI, 1.02-1.29]), and log cig-years had the lowest AIC linear value when modeling noncancer survival.

Conclusions and relevance: In this cohort study, smoking duration and log cig-years best modeled a linear relationship with OS for patients with HNSCC. Both metrics maintained robust performance within specific clinicodemographic subgroups and anatomic subsites. Although most HNSCC survival models control for smoking exposure using smoking status or pack-years, duration and log cig-years may be superior metrics to account for the effects of smoking on survival.

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来源期刊
CiteScore
9.10
自引率
5.10%
发文量
230
期刊介绍: JAMA Otolaryngology–Head & Neck Surgery is a globally recognized and peer-reviewed medical journal dedicated to providing up-to-date information on diseases affecting the head and neck. It originated in 1925 as Archives of Otolaryngology and currently serves as the official publication for the American Head and Neck Society. As part of the prestigious JAMA Network, a collection of reputable general medical and specialty publications, it ensures the highest standards of research and expertise. Physicians and scientists worldwide rely on JAMA Otolaryngology–Head & Neck Surgery for invaluable insights in this specialized field.
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