Smoking impact on HPV driven head and neck cancer's oncological outcomes?. (July 2018) - Mirghani, Haitham
Highlights: HPV-driven OPC have overall a good prognosis. Smoking status at cancer diagnosis is the strongest prognostic factor for survival. Half of HPV-positive patients have a smoking history and almost 35% smoked more than 20 PY. Smoking cessation remains a priority in head and neck oncology even for HPV-positve patients. Abstract: Introduction: HPV-driven oropharyngeal cancer (OPC) patients have a better prognosis than their HPV-negative counterparts but several studies have suggested that among HPV-positive patients those with a smoking history had worse oncological outcomes. The aim of our study is to characterize the interplay between tobacco consumption, patient and disease characteristics, and disease control. Materials and methods: All patients diagnosed with HPV-driven OPC and treated with curative intent between 2007 and 2009 and 2011–2016 at Gustave Roussy cancer center were included (n = 282). Demographic, clinical, morphological and tobacco consumption were correlated with oncologic outcomes. Results: 157 (56%) patients had a positive smoking history, including 23.8% who were smoking at the time of diagnosis and 37.6% who had a tobacco consumption exceeding 20 pack-years. In multivariate analysis, the strongest prognostic factor for survival was smoking status at cancer diagnosis, with a hazard ratio (HR) for non-smokers compared to smokers of 0.25 ([0.12, 0.50], p = 0.0001). Smoking history, either more than 20 pack-years or smoking at diagnosis, was associated with local relapse and distant relapse. There was no difference in terms of comorbidity (p = 0.32) and radiotherapy duration (p = 0.93) according to tobacco consumption. Discussion: Smoking is frequent among patients with HPV-driven OPC and increases the risk of death and oncologic failure.