Intravenous Opioid Drug Abuse as an Independent Risk Factor for Supraglottic Squamous Cell Carcinoma – A Case Control Study

Abstract

Objectives

Intravenous opioid drug abuse (IVDA) was previously correlated with laryngeal cancer. However, discrimination of this correlation by anatomical subsites has not yet been described. In this study we aim to further establish the association between IVDA and laryngeal squamous cell carcinoma (SCC) and to indicate the laryngeal subsites that are predisposed for this correlation.

Design

A retrospective matched case control study.

Setting and Participants

Patients diagnosed with supraglottic SCC (SG-SCC) between 1996 and 2016 treated in a tertiary academic referral center were enrolled to the case group. The control group comprised of matched patients diagnosed with glottis SCC (G-SCC). Matching was based on gender, age and socioeconomic rank.

Main outcome measures

Variables studies as risk factors included: smoking, alcohol consumption, history of IVDA and infectious diseases. The variables were tested for association with the two groups and with each other.

Results

Forty eight patients with SG-SCC were matched with 48 G-SCC patients. IVDA rates significantly increased among SG-SCC patients. Of the SG-SCC group, 18.8% had a positive history for IVDA compared with 2.1% of the G-SCC (p-value=0.008). A history of IVDA was found to be a risk factor for SG-SCC, independent of smoking, excessive alcohol, and socioeconomic status. The odds ratio for patients with an IVDA history to have SG-SCC relatively to G-SCC was 10.846 (95% CI:1.3-89.4).

Conclusions

IVDA represent an independent risk factor for SG-SCC. The pathogenesis should be investigated not just as a risk factor, since opioids are commonly used for pain management in oncologic patients.

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