Impact of active smoking on outcomes in HPV+ oropharyngeal cancer

Head Neck. 2020 Feb;42(2):269-280. doi: 10.1002/hed.26001. Epub 2019 Nov 26.

Abstract

Background: The role of smoking among patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) is unclear.

Methods: A retrospective cohort study of patients with HPV(+) OPSCC from 2001 to 2015 at a tertiary-care institution was conducted. The primary outcome was overall survival (OS).

Results: Among 484 included patients, 94 (19.4%) were active smokers, 226 (46.7%) were former smokers, and 164 (33.9%) never smoked. Among active smokers, 82 patients (87.2%) had a ≥10 pack-year and 69 (73.4%) had a ≥20 pack-year smoking history. After adjusting for covariates, active smoking was a significant predictor of inferior OS (HR 2.28, P < .001) and PFS (HR 2.26, P < .001). When including pack-years as the covariate, ≥20 pack-years predicted a decreased effect-size for inferior OS and PFS.

Conclusions: For patients with HPV(+) OPSCC, active smoking at diagnosis is the most powerful covariate capturing smoking history to predict OS and PFS.

Keywords: human papillomavirus; oropharyngeal cancer; overall survival; pack-years; smoking status.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Head and Neck Neoplasms*
  • Humans
  • Oropharyngeal Neoplasms* / epidemiology
  • Papillomavirus Infections* / complications
  • Papillomavirus Infections* / epidemiology
  • Prognosis
  • Retrospective Studies
  • Smoking / adverse effects