Top

11-03-2016 | Head and neck cancers | Article

Pretreatment oral hygiene habits and survival of head and neck squamous cell carcinoma (HNSCC) patients

Journal: BMC Oral Health

Authors: Juliane Friemel, Ronja Foraita, Kathrin Günther, Mathias Heibeck, Frauke Günther, Maren Pflueger, Hermann Pohlabeln, Thomas Behrens, Jörn Bullerdiek, Rolf Nimzyk, Wolfgang Ahrens

Publisher: BioMed Central

Abstract

Background

The survival time of patients with head and neck squamous cell carcinoma (HNSCC) is related to health behavior, such as tobacco smoking and alcohol consumption. Poor oral health (OH), dental care (DC) and the frequent use of mouthwash have been shown to represent independent risk factors for head and neck cancerogenesis, but their impact on the survival of HNSCC patients has not been systematically investigated.

Methods

Two hundred seventy-six incident HNSCC cases recruited for the ARCAGE study were followed through a period of 6–10 years. Interview-based information on wearing of dentures, gum bleeding, teeth brushing, use of floss and dentist visits were grouped into weighted composite scores, i.e. oral health (OH) and dental care (DH). Use of mouthwash was assessed as frequency per day. Also obtained were other types of health behavior, such as smoking, alcohol drinking and diet, appreciated as both confounding and study variables. Endpoints were progression-free survival, overall survival and tumor-specific survival. Prognostic values were estimated using Kaplan-Meier analysis and Cox proportional hazards regression models.

Results

A good dental care score, summarizing annual dental visits, daily teeth cleaning and use of floss was associated with longer overall survival time (p = .001). The results of the Cox regression models similarly suggested a higher risk of tumor progression and shortened overall survival in patients with poor dental care, but the results lost their statistical significance after other types of health behavior had been controlled for. Frequent use of mouthwash (≥ 2 times/day) significantly increased the risk of tumor-specific death (HR = 2.26; CI = 1.19–4.32). Alcohol consumption and tobacco smoking were dose-dependently associated with tumor progression and shorter overall survival.

Conclusion

Frequent mouthwash use of ≥ 2 times/day seems to elevate the risk of tumor-specific death in HNSCC patients. Good dental care scores are associated with longer overall survival.

Parfenov M, Pedamallu CS, Gehlenborg N, Freeman SS, Danilova L, Bristow CA, et al. Characterization of HPV and host genome interactions in primary head and neck cancers. Proc Natl Acad Sci U S A. 2014;111(43):15544–9.CrossRefPubMedPubMedCentral

Ferlay J, Parkin DM, Steliarova-Foucher E. Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer. 2010;46(4):765–81.CrossRefPubMed

Robert Koch-Institut und die Gesellschaft der epidemiologischen Krebsregister in Deutschland e V. Krebs in Deutschland 2007/2008. H„ufigkeiten und Trends. In: Auflage. 7th ed. Berlin: RKI; 2010.

Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, et al. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–403.CrossRefPubMed

Dayyani F, Etzel CJ, Liu M, Ho CH, Lippman SM, Tsao AS. Meta-analysis of the impact of human papillomavirus (HPV) on cancer risk and overall survival in head and neck squamous cell carcinomas (HNSCC). Head Neck Oncol. 2010;2:15.CrossRefPubMedPubMedCentral

Lubin JH, Purdue M, Kelsey K, Zhang ZF, Winn D, Wei Q, et al. Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case–control studies. Am J Epidemiol. 2009;170(8):937–47.CrossRefPubMedPubMedCentral

Macfarlane TV, Macfarlane GJ, Oliver RJ, Benhamou S, Bouchardy C, Ahrens W, et al. The aetiology of upper aerodigestive tract cancers among young adults in Europe: the ARCAGE study. Cancer Causes Control. 2010;21(12):2213–21.CrossRefPubMed

O’Rorke MA, Ellison MV, Murray LJ, Moran M, James J, Anderson LA. Human papillomavirus related head and neck cancer survival: A systematic review and meta-analysis. Oral Oncol. 2012;48(12):1191–201.CrossRefPubMed

Boeing H, Dietrich T, Hoffmann K, Pischon T, Ferrari P, Lahmann PH, et al. Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: the prospective EPIC-study. Cancer Causes Control. 2006;17(7):957–69.CrossRefPubMed

10.

Freedman ND, Park Y, Subar AF, Hollenbeck AR, Leitzmann MF, Schatzkin A, et al. Fruit and vegetable intake and head and neck cancer risk in a large United States prospective cohort study. Int J Cancer. 2008;122(10):2330–6.CrossRefPubMed

11.

Pavia M, Pileggi C, Nobile CG, Angelillo IF. Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies. Am J Clin Nutr. 2006;83(5):1126–34.PubMed

12.

Sapkota A, Hsu CC, Zaridze D, Shangina O, Szeszenia-Dabrowska N, Mates D, et al. Dietary risk factors for squamous cell carcinoma of the upper aerodigestive tract in central and eastern Europe. Cancer Causes Control. 2008;19(10):1161–70.CrossRefPubMed

13.

Lagiou P, Talamini R, Samoli E, Lagiou A, Ahrens W, Pohlabeln H, et al. Diet and upper-aerodigestive tract cancer in Europe: the ARCAGE study. International journal of cancer Journal international du cancer. 2009;124(11):2671–6.CrossRefPubMed

14.

Ahrens W, Pohlabeln H, Foraita R, Nelis M, Lagiou P, Lagiou A, et al. Oral health, dental care and mouthwash associated with upper aerodigestive tract cancer risk in Europe: The ARCAGE study. Oral Oncol. 2014;50(6):616–25.CrossRefPubMed

15.

Chang JS, Lo HI, Wong TY, Huang CC, Lee WT, Tsai ST, et al. Investigating the association between oral hygiene and head and neck cancer. Oral Oncol. 2013;49(10):1010–7.CrossRefPubMed

16.

Eliot MN, Michaud DS, Langevin SM, McClean MD, Kelsey KT. Periodontal disease and mouthwash use are risk factors for head and neck squamous cell carcinoma. Cancer Causes Control. 2013;24(7):1315–22.CrossRefPubMedPubMedCentral

17.

Marques LA, Eluf-Neto J, Figueiredo RA, Gois-Filho JF, Kowalski LP, Carvalho MB, et al. Oral health, hygiene practices and oral cancer. Rev Saude Publica. 2008;42(3):471–9.CrossRefPubMed

18.

Day GL, Blot WJ, Shore RE, McLaughlin JK, Austin DF, Greenberg RS, et al. Second cancers following oral and pharyngeal cancers: role of tobacco and alcohol. J Natl Cancer Inst. 1994;86(2):131–7.CrossRefPubMed

19.

Dikshit RP, Boffetta P, Bouchardy C, Merletti F, Crosignani P, Cuchi T, et al. Lifestyle habits as prognostic factors in survival of laryngeal and hypopharyngeal cancer: a multicentric European study. Int J Cancer. 2005;117(6):992–5.CrossRefPubMed

20.

Duffy SA, Ronis DL, McLean S, Fowler KE, Gruber SB, Wolf GT, et al. Pretreatment health behaviors predict survival among patients with head and neck squamous cell carcinoma. J Clin Oncol. 2009;27(12):1969–75.CrossRefPubMedPubMedCentral

21.

Mayne ST, Cartmel B, Kirsh V, Goodwin Jr WJ. Alcohol and tobacco use prediagnosis and postdiagnosis, and survival in a cohort of patients with early stage cancers of the oral cavity, pharynx, and larynx. Cancer Epidemiol Biomarkers Prev. 2009;18(12):3368–74.CrossRefPubMedPubMedCentral

22.

Franceschi S, Levi F, Dal ML, Talamini R, Conti E, Negri E, et al. Cessation of alcohol drinking and risk of cancer of the oral cavity and pharynx. Int J Cancer. 2000;85(6):787–90.CrossRefPubMed

23.

Giersiepen K, Brunings-Kuppe C, Lehmann C. [The Bremen mortality index]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2004;47(5):451–6.CrossRefPubMed

24.

Manoharan S, Nagaraja V, Eslick GD. Ill-fitting dentures and oral cancer: a meta-analysis. Oral Oncol. 2014;50(11):1058–61.CrossRefPubMed

25.

Moergel M, Kammerer P, Kasaj A, Armouti E, Alshihri A, Weyer V, et al. Chronic periodontitis and its possible association with oral squamous cell carcinoma - a retrospective case control study. Head Face Med. 2013;9:39.CrossRefPubMedPubMedCentral

26.

Kruger M, Hansen T, Kasaj A, Moergel M. The Correlation between Chronic Periodontitis and Oral Cancer. Case reports in dentistry. 2013;2013:262410.CrossRefPubMedPubMedCentral

27.

Tezal M, Sullivan MA, Hyland A, Marshall JR, Stoler D, Reid ME, et al. Chronic periodontitis and the incidence of head and neck squamous cell carcinoma. Cancer Epidemiol Biomark Prev. 2009;18(9):2406–12.CrossRef

28.

Thomas DC. Invited commentary: is it time to retire the “pack-years” variable? Maybe not! Am J Epidemiol. 2014;179(3):299–302.CrossRefPubMedPubMedCentral

29.

de Roda Husman AM, Walboomers JM, van den Brule AJ, Meijer CJ, Snijders PJ. The use of general primers GP5 and GP6 elongated at their 3′ ends with adjacent highly conserved sequences improves human papillomavirus detection by PCR. J Gen Virol. 1995;76(Pt 4):1057–62.CrossRefPubMed

30.

Pytynia KB, Grant JR, Etzel CJ, Roberts DB, Wei Q, Sturgis EM. Matched-pair analysis of survival of never smokers and ever smokers with squamous cell carcinoma of the head and neck. J Clin Oncol. 2004;22(19):3981–8.CrossRefPubMed

31.

Divaris K, Olshan AF, Smith J, Bell ME, Weissler MC, Funkhouser WK, et al. Oral health and risk for head and neck squamous cell carcinoma: the Carolina Head and Neck Cancer Study. Cancer Causes Control. 2010;21(4):567–75.CrossRefPubMedPubMedCentral

32.

Guha N, Boffetta P, Wunsch Filho V, Eluf Neto J, Shangina O, Zaridze D, et al. Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: results of two multicentric case–control studies. Am J Epidemiol. 2007;166(10):1159–73.CrossRefPubMed

33.

Winn DM, Blot WJ, McLaughlin JK, Austin DF, Greenberg RS, Preston-Martin S, et al. Mouthwash use and oral conditions in the risk of oral and pharyngeal cancer. Cancer Res. 1991;51(11):3044–7.PubMed

34.

Winn DM, Diehl SR, Brown LM, Harty LC, Bravo-Otero E, Fraumeni Jr JF, et al. Mouthwash in the etiology of oral cancer in Puerto Rico. Cancer Causes Control. 2001;12(5):419–29.CrossRefPubMed

35.

Gandini S, Negri E, Boffetta P, La Vecchia C, Boyle P. Mouthwash and oral cancer risk quantitative meta-analysis of epidemiologic studies. Ann Agric Environ Med. 2012;19(2):173–80.PubMed

36.

Warnakulasuriya S. Causes of oral cancer--an appraisal of controversies. Br Dent J. 2009;207(10):471–5.CrossRefPubMed

37.

Santos A, Pascual A, Llopis J, Giner L, MK D, Levi Jr P, et al. Self-reported Oral Hygiene Habits in Smokers and Nonsmokers Diagnosed with Periodontal Disease. Oral Health Prev Dent. 2015;13(3):245–51.PubMed

38.

Austin PC, Brunner LJ. Inflation of the type I error rate when a continuous confounding variable is categorized in logistic regression analyses. Stat Med. 2004;23(7):1159–78.CrossRefPubMed

39.

Shen GP, Xu FH, He F, Ruan HL, Cui C, Chen LZ, et al. Pretreatment lifestyle behaviors as survival predictors for patients with nasopharyngeal carcinoma. PLoSOne. 2012;7(5):e36515.CrossRef

40.

Marron M, Boffetta P, Zhang ZF, Zaridze D, Wunsch-Filho V, Winn DM, et al. Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. Int J Epidemiol. 2010;39(1):182–96.CrossRefPubMedPubMedCentral

41.

van Imhoff LC, Kranenburg GG, Macco S, Nijman NL, van Overbeeke EJ, Wegner I, Grolman W, Pothen AJ. Prognostic value of continued smoking on survival and recurrence rates in patients with head and neck cancer: A systematic review. Head Neck. 2015. doi:10.1002/hed.24082 [Epub ahead of print]