title: Cigarette use, comorbidities, and prognosis in a prospective head and neck squamous cell carcinoma population.
abstract: To better understand the associations between a history of tobacco use and survival outcomes, cigarette use was prospectively surveyed in 687 previously untreated patients with cancer of the oral cavity (n = 271), oropharynx (n = 257), larynx (n = 135), or hypopharynx (n = 24).
  
  
  
  Kaplan-Meier and Cox models explored the associations of tobacco use intensity (packs/day), duration (years of use), and timing before diagnosis with overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS).
  
  
  
  Cigarette use duration, timing, and intensity were significant predictors for all outcomes in univariate analysis. Never smoking and pack-years were not significantly associated with outcomes after adjustment for prognostic factors, such as stage, comorbidities, and human papillomavirus (HPV) status, which were strongly associated with clinical outcomes.
  
  
  
  The findings confirm the association between smoking history and survival and the importance of clinical variables in evaluating smoking as a prognostic factor. Timing, intensity, and duration of cigarette use should be considered with other prognostic factors when considering risk stratification for treatment planning. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1810-1820, 2016.
authors.affiliation: Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Peterson
authors.affiliation: Center for Cancer Biostatistics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Bellile
authors.affiliation: Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Wolf
authors.affiliation: Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Shama
authors.initials: S
authors.lastname: Virani
authors.affiliation: Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Shuman
authors.affiliation: Center for Cancer Biostatistics, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Jeremy M G
authors.initials: JM
authors.lastname: Taylor
authors.affiliation: Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, Michigan.|Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Rozek
mesh_terms: D017677:Age Distribution; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D002423:Cause of Death; D000073865:Cigarette Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
keywords: comorbidities; duration; epidemiology; head and neck cancer; intensity; recurrence; survival; tobacco