Table 1-.
Summary of studies comparing prognosis of OSCC in non-smokers and nondrinkers vs. smokers and drinkers
| Author | No. of Subjects | Definition of NSND | Anatomical Subsites in Non-Smokers | Analysis | Conclusions | Reported Data |
|---|---|---|---|---|---|---|
| Andersen et al. (PMID: 35114883) 2022 | Never smokers (n =240) Former smoker (n = 339) Current smoker (n = 1138) |
Non-smoker = never smoked a cigarette No analysis of drinking |
Tongue = 53.8% Gingiva = 21.3% Floor of mouth = 7.9% Other = 15.8% Unknown = 1.3% |
Kaplan-Meier Log-rank test Multivariable Cox regression |
- Non-smokers have better OS and DFS - Dose dependent relationship between accumulated amount of tobacco use and survival estimates |
5-year OS HR (95% CI) Never smoker 1 (ref) Current smoker 1.83 (1.38–2.42) Former smoker 1.32 (0.98–1.77) 5-year DFS HR (95% CI) Never smoker 1 (ref) Current smoker 1.32 (1.04–1.68) Former smoker 1.17 (0.90–1.51) |
| Adeoye et al. (PMID: 33991259) 2021 | NSND (n=171) ESED (n=142) |
Non-smoker = no history of tobacco smoking Non-drinker = no history of alcohol consumption |
Tongue = 52.6% Gingiva = 22.8% Floor of mouth = 1.8% Buccal = 18.7% Retromolar = 2.3% Hard palate = 1.8% |
Kaplan- Meier Log-rank test Multivariable Cox regression |
- NSND have better OS - No difference in RFS and DSS |
5-year OS HR (95% CI) ESED 1 (ref) NSND 0.47 (0.29–0.75) 5-year DFS HR (95% CI) ESED 1 (ref) NSND 1.14 (0.42–3.05) |
| Yang et al. (PMID: 34262853) 2021 | NSND (n = 86) E SED (n = 267) |
Non-smoker = ≤100 cigarettes in lifetime Non-drinker = drank wine no more than once every 2 weeks |
Tongue = 43% Gingiva = 26.7% Floor of mouth = 7% Buccal = 23.3% |
Kaplan-Meier Log-rank test Multivariable Cox regression |
- NSND have better LRC and DSS | 5-year LRC NSND 48% ESED 38% (p=0.048) 5-year DSS NSND 56% ESED 39% (p=0.047) |
| Koo et al. (PMID: 33804510) 2021 | NSND (n = 59) E SED (n = 117) |
Non-smoker = <100 cigarettes in lifetime Non-drinker = <1 standard drink per week |
Subsites not reported | Kaplan-Meier Log-rank test Multivariable Cox regression |
- No difference in OS | 5-year OS HR (95% CI) ESED 1 (ref) NSND 1.1 (0.6–2.1) |
| Bao et al. (PMID: 32031313) 2020 | NSND (n = 646) ESED (n = 519) |
Non-smoker = <10 pack-years of cigarette use Non-drinker = <7 drinks per week continuously for at least 1 year |
Subsites not reported | Kaplan-Meier Log-rank test Multivariable Cox regression |
- NSND have better OS and DSS | All-cause death HR (95% CI) NSND 1 (ref) ESED 1.897 (1.138–3.165) Oral cancer-specific death HR (95% CI) NSND 1 (ref) ESED 1.764 (1.043–2.983) |
| DeAngelis et al. (PMID: 30409291) 2018 | NSND (n=70) ESED (n=217) |
Non-smoker = <5 cigarettes/week in lifetime Non-drinker = <3 standard drinks/week in lifetime |
Tongue = 51.2% Gingiva = 19.5% Floor of mouth = 9.8% Buccal = 7.0% Retromolar = 19.5% Hard palate = 3.9% Vestibule = 0.8% |
Kaplan-Meier Log-rank test Multivariable Cox regression |
- Worse DSS in elderly NSND females compared to elderly SD patients. Otherwise, similar DSS in NSND vs ESED - NSND have higher recurrence rates |
5-year DSS HR (95% CI) Age-matched female ESED 1 (ref) Elderly female NSND 2.97 (1.47–10.1) 5-year recurrence NSND 42.9% ESED 27.6% (p = 0.005) |
| Dediol et al. (PMID: 26993152) 2016 | NSND (n = 103) ESED (n = 971) |
Non-smoker = <10 packs per year Non-drinker = not daily alcohol consumption |
Tongue = 42% Gingiva = 25% Floor of mouth = 17% Buccal = 10% Retromolar = 4% Hard palate = 3% |
Kaplan- Meier Log-rank test Multivariable Cox regression |
- No difference in DSS, recurrence and metastasis | Cumulative survival HR (95% CI) NSND 1 (ref) Smoking 1 (0.98011.0124) Alcohol 0.63(0.2213 – 1.7762) |
| Fang et al. (PMID: 24820715) 2014 | Never smoker (n = 66) Ever smoker (n = 66) Current smoker (n = 66) |
Non-smoker = 100 cigarettes in lifetime Non-drinker = never drank alcohol weekly for a year |
Tongue = 48.5% Gingiva = 18.2% Floor of mouth = 15.2% Buccal = 6.1% Lip = 12.1% |
Matched-pair Kaplan-Meier Log-rank test |
- Better RFS and DSS in never smokers than ever smokers - Smoking increased risk for disease- related death by 5-fold |
Significant RFS rates in ever smokers vs never smokers (P = 0.006) Significant DSS rates in ever smokers vs never smokers (P = 0.027) |
| Fan et al. (PMID: 25374224) 2014 | NSND (n = 54) ESED (n = 46) |
Non-smoker = negligible history of tobacco use Non-drinker = <1 alcohol consumption per day with no history alcohol abuse |
Mobile tongue = 74.1% Other sites = 25.9% |
Kaplan-Meier Log-rank test |
- Nodifference in DFS or OS | 5-year OS NSND 76.7% ESED 73.9% (p=0.823) 5-year DFS NSND 61.4% ESED 60.4% (p=0.482) |
| Bachar et al. (PMID: 21167767) 2010 | NSND (n=116) ESED (n=175) |
Non-smoker = less than daily smoking history Non-drinker = ≤3 drinks per day |
Tongue = 100% | Kaplan-Meier Log-rank test Multivariable Cox regression |
- No difference in DFS and OS - However, young(<40 years) NSND have worse OS and DFS than young ESED - ESED have greater tumor depth of invasion and higher tumor grade |
5-year OS NSND 64% ESED 68% (p=0.53) 5-year DFS NSND 57% ESED 59% (p= 0.526) 5-year OS Young NSND 89% Young ESED 55% (p = 0.015) |
| 5-year DFS Young NSND 77% Young ESED 50% (p = 0.038) |
Abbreviations: CI, confidence interval; HR, hazard ratio; NSND, non-smoking and nondrinking; ESED, ever-smoker and ever-drinker; OS, overall survival; DFS, disease-free survival; LRC, locoregional control; DSS, disease-specific survival; RFS, recurrence-free survival