The influence of smoking, age and stage at diagnosis on the survival after larynx, hypopharynx and oral cavity cancers in Europe: The ARCAGE study

Renata Abrahão, Devasena Anantharaman, Valérie Gaborieau, Behnoush Abedi-Ardekani, Pagona Lagiou, Areti Lagiou, Wolfgang Ahrens, Ivana Holcatova, Jaroslav Betka, Franco Merletti, Lorenzo Richiardi, Kristina Kjaerheim, Diego Serraino, Jerry Polesel, Lorenzo Simonato, Laia Alemany, Antonio Agudo Trigueros, Tatiana V Macfarlane, Gary J Macfarlane, Ariana ZnaorMax Robinson, Cristina Canova, David I Conway, Sylvia Wright, Claire M Healy, Mary Toner, Gabriella Cadoni, Stefania Boccia, Tarik Gheit, Massimo Tommasino, Ghislaine Scelo, Paul Brennan

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Head and neck cancer (HNC) is a preventable malignancy that continues to cause substantial morbidity and mortality worldwide. Using data from the ARCAGE and Rome studies, we investigated the main predictors of survival after larynx, hypopharynx and oral cavity (OC) cancers. We used the Kaplan-Meier method to estimate overall survival, and Cox proportional models to examine the relationship between survival and sociodemographic and clinical characteristics. 604 larynx, 146 hypopharynx and 460 OC cancer cases were included in this study. Over a median follow-up time of 4.6 years, nearly 50% (n = 586) of patients died. Five-year survival was 65% for larynx, 55% for OC and 35% for hypopharynx cancers. In a multivariable analysis, we observed an increased mortality risk among older (≥71 years) versus younger (≤50 years) patients with larynx/hypopharynx combined (LH) and OC cancers [HR = 1.61, 95% CI 1.09-2.38 (LH) and HR = 2.12, 95% CI 1.35-3.33 (OC)], current versus never smokers [HR = 2.67, 95% CI 1.40-5.08 (LH) and HR = 2.16, 95% CI 1.32-3.54 (OC)] and advanced versus early stage disease at diagnosis [IV versus I, HR = 2.60, 95% CI 1.78-3.79 (LH) and HR = 3.17, 95% CI 2.05-4.89 (OC)]. Survival was not associated with sex, alcohol consumption, education, oral health, p16 expression, presence of HPV infection or body mass index 2 years before cancer diagnosis. Despite advances in diagnosis and therapeutic modalities, survival after HNC remains low in Europe. In addition to the recognized prognostic effect of stage at diagnosis, smoking history and older age at diagnosis are important prognostic indicators for HNC.

Original languageEnglish
Pages (from-to)32-44
Number of pages14
JournalInternational Journal of Cancer
Issue number1
Early online date23 Feb 2018
Publication statusPublished - 1 Jul 2018

Bibliographical note

Funded by
European Commission's 5th Framework Program (Paul Brennan, Principal Investigator) . Grant Number: QLK1-2011-00182
European Commission's 7th Framework Program (Massimo Tomassimo Principal Investigator) . Grant Number: FP7-HEALTH-2011-282562
Health General Directorate of the French Social Affairs and Health Ministry


  • head and neck cancer
  • predictors of survival
  • ARCAGE study


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