Association between Preexisting Sleep Disorders and Oncologic Outcome in Patients with Oral Cavity Squamous Cell Carcinoma: A Nationwide Propensity Score—Matched Population-Based Cohort Study
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Study Population
2.2. Inclusion and Exclusion Criteria
2.3. Propensity Score Matching and Covariates
2.4. Statistical Analysis
3. Results
3.1. PSM and Study Cohort
3.2. All-Cause Death
3.3. LRR
3.4. DM
3.5. Kaplan–Meier Survival and Cumulative Incidence of LRR and DM in Patients with OSCC with and without Sleep Disorders before Surgery
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Patients without Sleep Disorder | Patients with Sleep Disorder | p-Value | SMD | |||
---|---|---|---|---|---|---|
N = 1630 | N = 828 | |||||
N | % | N | % | |||
Age (mean ± SD) | 56.39 ± 12.88 | 57.42 ± 12.94 | 0.061 | 0.080 | ||
Age, median (IQR), years | 55.84 (47.55–64.85) | 56.16 (48.29–66.43) | 0.188 | |||
Age group, years | 1630 | 828 | 0.965 | 0.011 | ||
≤50 | 509 | 31.23% | 256 | 30.92% | ||
51–60 | 496 | 30.43% | 250 | 30.19% | ||
≥60 | 625 | 38.34% | 322 | 38.89% | ||
Sex | 0.432 | 0.014 | ||||
Female | 361 | 22.15% | 195 | 23.55% | ||
Male | 1269 | 77.85% | 633 | 76.45% | ||
Cancer location | 1630 | 828 | 0.613 | 0.042 | ||
Buccal | 715 | 43.87% | 379 | 45.77% | ||
Gingival, hard palate, and oral tongue | 804 | 49.33% | 391 | 47.22% | ||
Lip | 111 | 6.81% | 58 | 7.00% | ||
Pathologic AJCC stage | 0.960 | 0.001 | ||||
I | 479 | 29.39% | 240 | 28.99% | ||
II | 134 | 8.22% | 68 | 8.21% | ||
III | 421 | 25.83% | 214 | 25.85% | ||
IV | 596 | 36.56% | 306 | 36.96% | ||
Income (NT$) | 1630 | 828 | 0.082 | 0.129 | ||
Low income | 17 | 1.04% | 19 | 2.29% | ||
10,000–19,999 | 573 | 35.15% | 286 | 34.54% | ||
≤20,000 | 411 | 25.21% | 209 | 25.24% | ||
20,001–30,000 | 193 | 11.84% | 81 | 9.78% | ||
30,001–45,000 | 83 | 5.09% | 36 | 4.35% | ||
>45,000 | 353 | 21.66% | 197 | 23.79% | ||
Urbanization | 0.972 | 0.001 | ||||
Rural | 554 | 33.99% | 282 | 34.06% | ||
Urban | 1076 | 66.01% | 546 | 65.94% | ||
CCI scores | ||||||
Mean (SD) | 0.77 ± 1.05 | 0.93 ± 1.30 | 0.001 | 0.138 | ||
Median (IQR (Q1–Q3)) | 0.00 (0.00–1.00) | 0.00 (0.00–2.00) | 0.076 | |||
CCI scores | 1630 | 828 | 0.670 | 0.009 | ||
0 | 934 | 57.30% | 467 | 56.40% | ||
≥1 | 696 | 42.70% | 361 | 43.60% | ||
CCI comorbidities | ||||||
Congestive heart failure | 65 | 3.99% | 40 | 4.83% | 0.329 | 0.008 |
Dementia | 14 | 0.86% | 9 | 1.09% | 0.579 | 0.002 |
Chronic pulmonary disease | 309 | 18.96% | 161 | 19.44% | 0.771 | 0.005 |
Rheumatic disease | 16 | 0.98% | 7 | 0.85% | 0.740 | 0.001 |
Liver disease | 307 | 18.83% | 195 | 23.55% | 0.006 | 0.047 |
Diabetes with complications | 70 | 4.29% | 31 | 3.74% | 0.516 | 0.006 |
Hemiplegia and paraplegia | 0 | 0.00% | 1 | 0.12% | 0.161 | 0.001 |
Renal disease | 57 | 3.50% | 39 | 4.71% | 0.142 | 0.012 |
AIDS | 1630 | 100.00% | 828 | 100.00% | 0.000 | |
Alcohol liver diseases | 311 | 19.08% | 229 | 27.66% | <0.001 | 0.086 |
Cigarette smoking | 537 | 32.94% | 412 | 49.76% | <0.001 | 0.168 |
Betel nut chewing | 326 | 20.00% | 260 | 31.40% | <0.001 | 0.114 |
Adjuvant RT | 541 | 33.19% | 275 | 33.21% | 0.482 | 0.001 |
Adjuvant CCRT | 1089 | 66.81% | 553 | 66.79% | 0.481 | 0.001 |
Outcomes | ||||||
Mean (SD) follow-up | 5.42 ± 4.63 | 4.58 ± 3.31 | <0.001 | |||
Median (IQR (Q1–Q3)) follow-up | 5.14 (1.28–8.75) | 4.48 (0.86–5.53) | <0.001 | |||
All-cause death | 724 | 44.42% | 430 | 51.93% | <0.001 | |
Locoregional recurrence | 387 | 23.74% | 233 | 28.14% | <0.001 | |
Metastasis | 253 | 15.52% | 141 | 17.03% | <0.001 |
Crude HR (95%CI) | p-Value | Adjusted HR * (95%CI) | p-Value | |||
---|---|---|---|---|---|---|
Sleep disorder (ref. no.) | ||||||
Yes | 1.32 | (1.16–1.50) | 0.001 | 1.19 | (1.04–1.36) | 0.011 |
Age group, years (ref. ≤50) | ||||||
51–60 | 1.22 | (1.03–1.44) | 0.018 | 1.22 | (1.03–1.45) | 0.020 |
>60 | 1.90 | (1.64–2.20) | 0.001 | 1.67 | (1.42–1.98) | <0.001 |
Sex (ref. female) | ||||||
Male | 1.70 | (1.46–1.99) | 0.001 | 1.76 | (1.50–2.06) | <0.001 |
Income, NT$ (ref. low income) | ||||||
10,000–19,999 | 0.63 | (0.40–1.00) | 0.048 | 0.67 | (0.42–1.08) | 0.101 |
≤20,000 | 0.61 | (0.39–0.95) | 0.030 | 0.69 | (0.44–1.10) | 0.120 |
20,001–30,000 | 0.49 | (0.31–0.77) | 0.002 | 0.52 | (0.33–0.83) | 0.007 |
30,001–45,000 | 0.33 | (0.20–0.54) | 0.000 | 0.42 | (0.25–0.70) | 0.001 |
>45,000 | 0.24 | (0.14–0.43) | 0.000 | 0.28 | (0.16–0.51) | 0.000 |
Urbanization (ref. rural) | ||||||
Urban | 0.84 | (0.74–0.95) | 0.007 | 0.92 | (0.81–1.05) | 0.198 |
Cancer location (ref. buccal) | ||||||
Gingival, hard palate, and tongue | 0.93 | (0.82–1.05) | 0.218 | 1.06 | (0.92–1.22) | 0.440 |
Lip | 0.77 | (0.60–0.99) | 0.041 | 0.91 | (0.71–1.17) | 0.471 |
AJCC stage (ref. stage I) | ||||||
II | 1.47 | (1.11–1.95) | 0.0075 | 1.37 | (1.03–1.82) | 0.029 |
III | 2.36 | (1.96–2.85) | 0.001 | 2.44 | (2.02–2.95) | <0.001 |
IV | 2.45 | (2.05–2.93) | 0.001 | 2.86 | (2.36–3.46) | <0.001 |
CCI (ref. 0) | ||||||
≥1 | 1.45 | (1.29–1.64) | 0.001 | 1.19 | (1.05–1.36) | 0.007 |
Cigarette smoking (ref. no.) | 1.68 | (1.46–1.93) | 0.001 | 1.35 | (1.16–1.58) | <0.001 |
Betel nut chewing (ref. no.) | 1.58 | (1.39–1.79) | 0.001 | 1.07 | (1.02–1.14) | 0.008 |
Alcohol liver diseases (ref. no.) | 1.69 | (1.48–1.94) | 0.001 | 1.27 | (1.09–1.48) | 0.002 |
Adjuvant RT | 0.85 | (0.49–0.91) | 0.001 | 0.97 | (0.95–1.20) | 0.296 |
Adjuvant CCRT | 0.81 | (0.55–0.95) | 0.001 | 0.92 | (0.80–1.05) | 0.228 |
Crude HR (95%CI) | p-Value | Adjusted HR * (95%CI) | p-Value | |||
---|---|---|---|---|---|---|
Sleep disorder (ref. no.) | ||||||
Yes | 1.41 | (1.19–1.67) | 0.001 | 1.47 | (1.23–1.75) | <0.001 |
Age group, years (ref. ≤50) | ||||||
51–60 | 1.14 | (0.94–1.38) | 0.196 | 1.11 | (0.91–1.36) | 0.310 |
>60 | 0.91 | (0.74–1.10) | 0.327 | 1.00 | (0.80–1.25) | 0.993 |
Sex (ref. female) | ||||||
Male | 2.74 | (2.14–3.50) | 0.001 | 1.84 | (1.43–2.37) | <0.001 |
Income, NT$ (ref. low income) | ||||||
10,000–19,999 | 1.09 | (0.45–2.68) | 0.846 | 1.09 | (0.44–2.70) | 0.861 |
≤20,000 | 1.29 | (0.53–3.12) | 0.580 | 1.16 | (0.47–2.84) | 0.748 |
20,001–30,000 | 1.59 | (0.65–3.87) | 0.306 | 1.42 | (0.58–3.48) | 0.447 |
30,001–45,000 | 1.44 | (0.58–3.55) | 0.434 | 1.40 | (0.56–3.49) | 0.475 |
>45,000 | 0.87 | (0.33–2.29) | 0.779 | 0.97 | (0.36–2.59) | 0.953 |
Urbanization (ref. rural) | ||||||
Urban | 0.85 | (0.72–1.00) | 0.055 | 1.05 | (0.88–1.25) | 0.607 |
Cancer location (ref. buccal) | ||||||
Gingival, hard palate, and tongue | 1.15 | (0.54–1.82) | 0.329 | 1.11 | (0.91–1.22) | 0.452 |
Lip | 1.08 | (0.69–1.68) | 0.738 | 1.03 | (0.66–1.61) | 0.901 |
AJCC stage (ref. stage I) | ||||||
II | 1.25 | (1.00–1.56) | 0.055 | 1.35 | (1.08–1.70) | 0.010 |
III | 1.66 | (1.27–2.16) | 0.0002 | 1.64 | (1.25–2.15) | <0.001 |
IV | 2.04 | (1.69–2.47) | 0.001 | 1.93 | (1.60–2.33) | <0.001 |
CCI (ref. 0) | ||||||
≥1 | 1.09 | (0.92–1.28) | 0.3275 | 1.15 | (0.97–1.37) | 0.111 |
Cigarette smoking (ref. no.) | 1.21 | (1.02–1.43) | 0.0251 | 1.25 | (1.02–1.54) | 0.030 |
Betel nut chewing (ref. no.) | 1.29 | (1.14–1.47) | 0.001 | 1.26 | (1.08–1.48) | 0.003 |
Alcohol liver diseases (ref. no.) | 1.39 | (1.14–1.69) | 0.0009 | 1.04 | (0.83–1.30) | 0.737 |
Adjuvant RT | 0.44 | (0.22–0.89) | 0.022 | 0.69 | (0.49–0.79) | 0.009 |
Adjuvant CCRT | 0.30 | (0.13–0.73) | 0.008 | 0.56 | (0.41–0.83) | 0.003 |
Crude HR (95%CI) | p-Value | Adjusted HR * (95%CI) | p-Value | |||
---|---|---|---|---|---|---|
Sleep disorder (ref. no.) | ||||||
Yes | 1.29 | (1.03–1.60) | 0.025 | 1.15 | (1.02–1.44) | 0.025 |
Age group, years (ref. ≤50) | ||||||
51–60 | 1.02 | (0.79–1.31) | 0.873 | 1.04 | (0.8–1.34) | 0.795 |
>60 | 1.02 | (0.8–1.30) | 0.895 | 1.18 | (0.9–1.56) | 0.236 |
Sex (ref. female) | ||||||
Male | 2.02 | (1.53–2.67) | 0.001 | 1.63 | (1.22–2.18) | 0.001 |
Income, NT$ (ref. low income) | ||||||
10,000–19,999 | 3.09 | (0.43–22.25) | 0.263 | 4.45 | (0.61–32.46) | 0.141 |
≤20,000 | 3.76 | (0.53–26.89) | 0.187 | 4.75 | (0.66–34.37) | 0.123 |
20,001–30,000 | 4.22 | (0.59–30.24) | 0.152 | 5.01 | (0.69–36.25) | 0.111 |
30,001–45,000 | 2.68 | (0.37–19.55) | 0.331 | 3.39 | (0.46–25.12) | 0.231 |
>45,000 | 2.33 | (0.31–17.62) | 0.414 | 2.91 | (0.38–22.35) | 0.305 |
Urbanization (ref. rural) | ||||||
Urban | 0.84 | (0.68–1.04) | 0.101 | 0.88 | (0.71–1.10) | 0.258 |
Cancer location (ref. buccal) | ||||||
Gingival, hard palate, and tongue | 1.09 | (0.88–1.34) | 0.442 | 1.35 | (0.95–1.74) | 0.219 |
Lip | 0.74 | (0.47–1.15) | 0.184 | 0.94 | (0.66–1.63) | 0.877 |
AJCC stage (ref. stage I) | ||||||
II | 2.00 | (1.00–4.02) | 0.051 | 1.89 | (1.14–3.80) | 0.0076 |
III | 3.12 | (1.49–4.26) | 0.001 | 3.31 | (1.6–4.62) | <0.001 |
IV | 7.00 | (5.15–9.42) | 0.001 | 8.44 | (6.58–9.55) | <0.001 |
CCI (ref. 0) | ||||||
≥1 | 1.25 | (0.92–1.54) | 0.338 | 1.21 | (0.98–1.51) | 0.182 |
Cigarette smoking (ref. no.) | 1.16 | (0.98–1.37) | 0.079 | 1.12 | (0.94–1.34) | 0.210 |
Betel nut chewing (ref. no.) | 1.17 | (0.95–1.45) | 0.141 | 1.05 | (0.83–1.34) | 0.667 |
Alcohol liver diseases (ref. no.) | 1.13 | (0.95–1.34) | 0.164 | 1.02 | (0.83–1.25) | 0.843 |
Adjuvant RT | 0.85 | (0.4–1.80) | 0.679 | 1.41 | (0.65–3.04) | 0.388 |
Adjuvant CCRT | 0.86 | (0.43–1.72) | 0.661 | 1.49 | (0.73–3.05) | 0.275 |
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Ou, S.-H.; Chen, W.-M.; Shia, B.-C.; Wu, S.-Y.; Lin, H.-C. Association between Preexisting Sleep Disorders and Oncologic Outcome in Patients with Oral Cavity Squamous Cell Carcinoma: A Nationwide Propensity Score—Matched Population-Based Cohort Study. Cancers 2022, 14, 3420. https://doi.org/10.3390/cancers14143420
Ou S-H, Chen W-M, Shia B-C, Wu S-Y, Lin H-C. Association between Preexisting Sleep Disorders and Oncologic Outcome in Patients with Oral Cavity Squamous Cell Carcinoma: A Nationwide Propensity Score—Matched Population-Based Cohort Study. Cancers. 2022; 14(14):3420. https://doi.org/10.3390/cancers14143420
Chicago/Turabian StyleOu, Shih-Hao, Wan-Ming Chen, Ben-Chang Shia, Szu-Yuan Wu, and Hsuan-Chih Lin. 2022. "Association between Preexisting Sleep Disorders and Oncologic Outcome in Patients with Oral Cavity Squamous Cell Carcinoma: A Nationwide Propensity Score—Matched Population-Based Cohort Study" Cancers 14, no. 14: 3420. https://doi.org/10.3390/cancers14143420