Association between tobacco use and metastatic neck disease

Objectives/Hypothesis: Tobacco has multiple effects on connective tissues that might affect tumor behavior. This study examined the association between tobacco use and tumor behavior (lymphatic metastasis and extracapsular spread) in head and neck cancers. Study Design: Chart audit. Methods: Medical records of patients from the Department of Otolaryngology, University of Pittsburgh Medical Center (Pittsburgh, PA) with oral cavity, pharyngeal, and laryngeal cancers who underwent neck dissection were reviewed focusing on their tobacco use habits, as well as the clinical and pathological criteria of primary tumors and cervical lymph nodes. Univariate and multivariate analyses were performed to study the significance between pathological and tobacco use variables. Results: The study included 171 patients. Both univariate and multivariate analyses revealed significant associations between tobacco use and pathological findings. Cervical metastasis was observed in 100% of tobacco users and 54% of nonusers (P <.0001). Extracapsular spread was observed in 100% of tobacco users and 19% of nonusers (P <.0001). Tobacco use was independently associated with pathological nodal stage in multivariate analysis. Former users and light users of tobacco were not at reduced risk of cervical metastasis or extracapsular spread. Conclusions: The study demonstrates that tobacco use is a possible risk factor for cervical metastasis and extracapsular spread, which may be helpful information in planning therapy for patients with clinically staged node-negative necks.