Prognostic Significance of Smoking in Human Papillomavirus–Positive Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage. (15th April 2020)

• Record Type: Journal Article
• Authors: Chidambaram, Smrithi; Nakken, Erik R.; Kennedy, William; Thorstad, Wade L.; Chen, Stephanie Y.; Pipkorn, Patrik; Zevallos, Jose P.; Mazul, Angela L.
• Is Part Of: Laryngoscope. Volume 130:Number 8(2020)
• Page Start: 1961
• Page End: 1966
• Publication Date: 2020-04-15
• Subjects: Head and neck -- oropharynx -- human papillomavirus -- American Joint Committee on Cancer eighth edition stage -- statistics; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.28659
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objective: To determine the prognostic significance of smoking in human papillomavirus (HPV)‐positive oropharyngeal squamous cell carcinoma (OPSCC) when considering American Joint Committee on Cancer eighth edition (AJCC‐8) stage. Study Design: Retrospective cohort study. Methods: Three hundred seventeen HPV‐positive OPSCC patients with known AJCC‐8 stage and smoking status (<10 or ≥10 pack‐years) seen at a tertiary center from 1997 to 2017 were studied. We used the Kaplan‐Meier method to compare 5‐year overall survival (OS) by smoking status and by clinical AJCC‐8 stage and smoking status combined. Hazard ratios (HRs) were estimated with Cox proportional hazard regression for the independent effects of smoking and AJCC‐8 stage. We also studied pathologic stage and estimated the combined effects of smoking and clinical stage. Results: The ≥10 pack‐years smokers had worse 5‐year OS than <10 pack‐years smokers (93.6%; 95% confidence interval (CI): 89.7‐97.8 vs. 82.3%; 95% CI: 76.0%‐89.1%). When stratified by AJCC‐8 clinical stage, only stage I <10 pack‐years smokers (98.7%; 95% CI: 96.3%‐100.0%) had significantly better 5‐year OS than their ≥10 pack‐years (84.8%; 95% CI: 76.4%‐94.1%) counterparts. In a multivariable analysis, ≥10 pack‐years smoking was associated with increased hazard of death when adjusting for AJCC‐8 clinical (HR: 2.52; 95% CI: 1.16‐5.46) and pathologic (HR: 5.21; 95% CI: 1.47‐18.5) stage. In both analyses, stage III patients demonstrated worse survival than stage I, and smoking had greater impact at lower stages. Conclusions: Smoking is a negative prognosticator in HPV‐positive OPSCC and interacts with AJCC‐8 clinical stage. It is important to understand the impact of smoking in HPV‐positive disease when considering treatment plans and deintensification trials. Level of Evidence: 2b Laryngoscope, 130: 1961–1966, 2020