•Younger age at starting tobacco use was associated with higher HNC risk.•Age of starting tobacco was not associated with HNC risk after adjusting for tobacco use.•Increased HNC risk with younger ...start age appears to be mediated by cumulative tobacco use.
Tobacco use is a well-established risk factor for head and neck cancer (HNC). However, less is known about the potential impact of exposure to tobacco at an early age on HNC risk.
We analyzed individual-level data on ever tobacco smokers from 27 case-control studies (17,146 HNC cases and 17,449 controls) in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using random-effects logistic regression models.
Without adjusting for tobacco packyears, we observed that younger age at starting tobacco use was associated with an increased HNC risk for ever smokers (OR<10 years vs. ≥30 years: 1.64, 95% CI: 1.35, 1.97). However, the observed association between age at starting tobacco use and HNC risk became null after adjusting for tobacco packyears (OR<10 years vs. ≥30 years: 0.97, 95% CI: 0.80, 1.19). In the stratified analyses on HNC subsites by tobacco packyears or years since quitting, no difference in the association between age at start and HNC risk was observed.
Results from this pooled analysis suggest that increased HNC risks observed with earlier age at starting tobacco smoking are largely due to longer duration and higher cumulative tobacco exposures.
The possible role of dietary fiber in the etiology of head and neck cancers (HNCs) is unclear. We used individual-level pooled data from 10 case-control studies (5959 cases and 12,248 controls) ...participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium, to examine the association between fiber intake and cancer of the oral cavity/pharynx and larynx. Odds Ratios (ORs) and their 95% Confidence Intervals (CIs) were estimated using unconditional multiple logistic regression applied to quintile categories of non-alcohol energy-adjusted fiber intake and adjusted for tobacco and alcohol use and other known or putative confounders.
Fiber intake was inversely associated with oral and pharyngeal cancer combined (OR for 5th vs. 1st quintile category = 0.49, 95% CI: 0.40-0.59;
p
for trend <0.001) and with laryngeal cancer (OR = 0.66, 95% CI: 0.54-0.82,
p
for trend <0.001). There was, however, appreciable heterogeneity of the estimated effect across studies for oral and pharyngeal cancer combined. Nonetheless, inverse associations were consistently observed for the subsites of oral and pharyngeal cancers and within most strata of the considered covariates, for both cancer sites.
Our findings from a multicenter large-scale pooled analysis suggest that, although in the presence of between-study heterogeneity, a greater intake of fiber may lower HNC risk.
Evidence of associations between single nutrients and head and neck cancer (HNC) is still more limited and less consistent than that for fruit and vegetables. However, clarification of the protective ...mechanisms of fruit and vegetables is important to our understanding of HNC etiology. We investigated the association between vitamin C intake from natural sources and cancer of the oral cavity/pharynx and larynx using individual‐level pooled data from ten case‐control studies (5,959 cases and 12,248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium. After harmonization of study‐specific exposure information via the residual method, adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were estimated using unconditional multiple logistic regression models on quintile categories of 'non‐alcohol energy‐adjusted' vitamin C intake. In the presence of heterogeneity of the estimated ORs among studies, we derived those estimates from generalized linear mixed models. Higher intakes of vitamin C were inversely related to oral and pharyngeal (OR = 0.54, 95% CI: 0.45–0.65, for the fifth quintile category versus the first one,
p
for trend<0.001) and laryngeal cancers (OR = 0.52, 95% CI: 0.40–0.68,
p
for trend = 0.006), although in the presence of heterogeneity among studies for both sites. Inverse associations were consistently observed for the anatomical subsites of oral and pharyngeal cancer, and across strata of age, sex, education, body mass index, tobacco, and alcohol, for both cancer sites. The inverse association of vitamin C intake from foods with HNC may reflect a protective effect on these cancers; however, we cannot rule out other explanations.
What's new?
A diet rich in fruits and vegetables is thought to offer protection against head and neck cancers (HNC). However, it has not been clear which specific nutrients might play a role in this effect. In this re‐analysis of several previous studies, the authors found that a higher intake of vitamin C from natural sources was associated with a significantly lower risk of anatomical subsites of HNC.
Background:
Although rare, postoperative cerebrospinal fluid (CSF) leak, diabetes insipidus, and meningitis are potential life-threatening complications of trans-sphenoidal pituitary surgery. As ...such, they tend to require longer hospitalizations and therefore increased costs. The purpose of this study was to quantify the effect each of these complications has on hospital length of stay, total charge, and perioperative death. We also aimed to analyze these complications, and how they differ between centers that perform this procedure at high volumes versus those that operate at a lower volume as well as between teaching and nonteaching hospitals.
Methods:
Using the nationwide inpatient sample (NIS) database of the Healthcare Cost and Utilization Project (HCUP), we were able to identify patients who underwent complete or partial excision of the pituitary using a trans-sphenoidal approach. Using ICD-9 diagnosis codes, patients were identified who developed a postoperative CSF leak, diabetes insipidus, or meningitis. Surgical centers were compared based on surgical volume, using 50 cases per year as cutoffs, as well as teaching status. Chi-square analysis was performed to compare categorical variables and Student
t
-test was performed to analyze continuous variables when necessary.
Results:
A total of 9,107 patients were identified from the database that met the above criteria. The postoperative CSF leak was associated with an almost threefold increase in length of stay (
p
< 0.001), double the total charge (
p
< 0.001), but no increase in 30-day postoperative mortality (
p
= 0.62). If a patient was noted to develop meningitis postoperatively, it was associated with an almost sixfold increase in length of stay (
p
< 0.001), an almost fivefold increase in total charge (
p
< 0.001), as well as a 11% chance of mortality compared with 0.3% chance in those not developing meningitis (
p
< 0.001). With regards to hospital case volume, there was no difference in CSF leak (
p
= 0.97), diabetes insipidus (
p
= 0.79), or meningitis (
p
= 0.16) rates between high- and low-volume centers. In analyzing the teaching status of the hospital, there was no difference in CSF leak (
p
= 0.40), diabetes insipidus (
p
= 0.64), or meningitis (
p
= 0.28) rates when comparing teaching and nonteaching hospital complications.
Conclusion:
Postoperative complications have a tremendous burden on hospital resources and patients. The increased perioperative mortality as well as the significant increase in cost and days spent in the hospital further reinforces that well-trained surgeons in facilities equipped to diagnose, manage, and treat potential complications should perform these procedures. However, centers that perform trans-sphenoidal pituitary surgery at a higher volume do not show a decrease in the studied complication rates. Although it is not possible to account for tumor size or complexity using this database, one could assume that centers with a larger volume and teaching hospitals are more experienced, and thus would encounter more complicated cases at presentation.
There are suggestions of an inverse association between folate intake and serum folate levels and the risk of oral cavity and pharyngeal cancers (OPCs), but most studies are limited in sample size, ...with only few reporting information on the source of dietary folate. Our study aims to investigate the association between folate intake and the risk of OPC within the International Head and Neck Cancer Epidemiology (INHANCE) Consortium. We analyzed pooled individual‐level data from ten case–control studies participating in the INHANCE consortium, including 5,127 cases and 13,249 controls. Odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) were estimated for the associations between total folate intake (natural, fortification and supplementation) and natural folate only, and OPC risk. We found an inverse association between total folate intake and overall OPC risk (the adjusted OR for the highest
vs
. the lowest quintile was 0.65, 95% CI: 0.43–0.99), with a stronger association for oral cavity (OR = 0.57, 95% CI: 0.43–0.75). A similar inverse association, though somewhat weaker, was observed for folate intake from natural sources only in oral cavity cancer (OR = 0.64, 95% CI: 0.45–0.91). The highest OPC risk was observed in heavy alcohol drinkers with low folate intake as compared to never/light drinkers with high folate (OR = 4.05, 95% CI: 3.43–4.79); the attributable proportion (AP) owing to interaction was 11.1% (95% CI: 1.4–20.8%). Lastly, we reported an OR of 2.73 (95% CI:2.34‐3.19) for those ever tobacco users with low folate intake, compared with nevere tobacco users and high folate intake (AP of interaction =10.6%, 95% CI: 0.41‐20.8%). Our project of a large pool of case–control studies supports a protective effect of total folate intake on OPC risk.
What's new?
Folate is essential to DNA synthesis and repair, suggesting that folate deficiency, in disrupting normal DNA processes, may facilitate the development of certain cancers, including oral and pharyngeal cancer (OPC). The relationship between folate intake and risk of OPC, however, is unclear. In this analysis of data from the International Head and Neck Cancer Epidemiology (INHANCE) Consortium, high levels of folate intake were found to be inversely associated with overall OPC risk. The association was strongest for cancer of the oral cavity. Risk of OPC was highest among heavy alcohol drinkers with low folate levels.
PDF
