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  • Description:
  • ImportanceNonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, are commonly prescribed medications with anti-inflammatory and antiplatelet properties used long term to decrease the risk of cardiovascular events. A recent study showed that aspirin was associated with improved survival in patients with head and neck squamous cell carcinoma (HNSCC) who were treated with surgery. ObjectiveTo examine whether use of NSAIDs during definitive chemoradiation therapy (CRT) was associated with improved outcomes in patients with HNSCC. Design, Setting, and ParticipantsThis cohort study analyzed patients with HNSCC who were treated with CRT at a single institution between January 1, 2005, and August 1, 2017. Patient and tumor characteristics included age, race/ethnicity, smoking status, alcohol use, comorbidities (respiratory, cardiovascular, immune, renal, endocrine), disease stage, human papillomavirus status, and treatment duration. Data were analyzed from May 1, 2019, to March 17, 2020. ExposuresPatients were dichotomized by NSAID use during treatment. Main Outcomes and MeasuresThe association of NSAID use with patterns of failure, disease-specific survival (DSS), and overall survival (OS) was examined using multivariate Cox proportional hazard regression models. Survival estimates for OS and DSS were generated using Kaplan-Meier survival curves. ResultsA total of 460 patients (median [interquartile range] age, 60 [53.9-65.6] years; 377 [82.0%] men) were included in the analysis. Among these patients, 201 (43.7%) were taking NSAIDs during treatment. On univariate analysis, NSAID use (hazard ratio [HR], 0.63; 95% CI, 0.43-0.92; P = .02) was associated with better OS. On Cox regression analysis, after backward selection adjustment for potentially confounding factors (age, smoking status, primary tumor site, human papillomavirus status, diabetes, stroke, hyperlipidemia), NSAID use remained significantly associated with better OS (HR, 0.59; 95% CI, 0.38-0.90; P = .02). NSAID use was associated with significantly better OS at 5 years compared with patients who did not take concurrent NSAIDs (63.6% [56 of 88 patients]; 95% CI, 58%-73% vs 56.1% [83 of 148 patients]; 95% CI, 50%-63%; P = .03). NSAID use was not associated with better DSS in univariate (HR, 0.82; 95% CI, 0.48-1.41; P = .47) or multivariate (HR, 0.98; 95% CI, 0.57-1.70; P = .44) analysis. NSAID use was not associated with better response to treatment (HR, 1.44; 95% CI, 0.91-2.27; P = .12) or distant failure (HR, 1.12; 95% CI, 0.68-1.84; P = .65). Change in local control with NSAID use was not statistically significant (HR, 0.59; 95% CI, 0.31-1.10; P = .10). Conclusions and RelevanceThis cohort study suggests a possible OS advantage for patients taking NSAIDs during chemoradiation for HNSCC. Further studies examining this association are warranted.
  • License:
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  • Rights Holder:
  • JAMA
  • License Rights Holder:
  • Copyright 2020 Iovoli AJ et al. JAMA Network Open.
  • Asset Type:
  • Text
  • Asset Subtype:
  • Article
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  • Portrait
  • Image Dimensions:
  • 1275 x 1650
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  • 308 KB
  • Creator:
  • Austin J. Iovoli, Gregory M. Hermann, Sung Jun Ma, Alexis J. Platek, Mark K. Farrugia, Edwin Yau, Kimberly E. Wooten, Hassan Arshad, Vishal Gupta, Moni A. Kuriakose, Wesley L. Hicks, Anurag K. Singh
  • Credit:
  • Iovoli, A. J., Hermann, G. M., Ma, S. J., Platek, A. J., Farrugia, M. K., Yau, E., Wooten, K. E., Arshad, H., Gupta, V., Kuriakose, M. A., Hicks, W. L., & Singh, A. K. (2020). Association of Nonsteroidal Anti-inflammatory Drug Use With Survival in Patients With Squamous Cell Carcinoma of the Head and Neck Treated With Chemoradiation Therapy. JAMA Network Open, 3(6), e207199. https://doi.org/10.1001/jamanetworkopen.2020.7199.
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  • Property Release:
  • No
  • Model Release:
  • No
  • Purchasable:
  • Yes
  • Sensitive Materials:
  • No
  • Article Authors:
  • Austin J. Iovoli, Gregory M. Hermann, Sung Jun Ma, Alexis J. Platek, Mark K. Farrugia, Edwin Yau, Kimberly E. Wooten, Hassan Arshad, Vishal Gupta, Moni A. Kuriakose, Wesley L. Hicks, Anurag K. Singh
  • Article Copyright Year:
  • Publication Volume:
  • 3
  • Publication Issue:
  • 6
  • Publication Date:
  • 06/30/2020
  • DOI:
  • https://doi.org/10.1001/jamanetworkopen.2020.7199

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