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Smoking cessation is associated with improved survival in oropharynx cancer treated by chemoradiation
Author(s) -
Platek Alexis J.,
Jayaprakash Vijayvel,
Merzianu Mihai,
Platek Mary E.,
Cohan David M.,
Hicks Wesley L.,
Marimuthu Sathiya P.,
Winslow Timothy B.,
Gupta Vishal,
Arshad Hassan,
Kuriakose Moni A.,
Dibaj Shiva,
Marshall James R.,
Reid Mary E.,
Warren Graham W.,
Singh Anurag K.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.26083
Subject(s) - medicine , hazard ratio , smoking cessation , proportional hazards model , oncology , multivariate analysis , cohort , cancer , retrospective cohort study , medical record , stage (stratigraphy) , confidence interval , pathology , paleontology , biology
Objectives/Hypothesis The effect of smoking and human papillomavirus (HPV) on overall survival (OS) of oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing concurrent chemotherapy (CCRT) remains unclear. Study Design Retrospective review. Methods Clinical characteristics of OPSCC patients treated between 2008 and 2015 with CCRT were abstracted from medical records. OS curves and multivariate cox proportional hazard ratios (HRs) were examined. Results Of 120 evaluable patients, 71% had HPV + tumors. Median follow‐up duration for the entire cohort was 41.5 months (range = 6–88 months). HPV + current smokers experienced significantly worse 5‐year OS (73% alive vs. 36% alive, P = .01) and there was a similar trend in HPV − current smokers (66% alive vs. 31% alive, P = .28) compared to former/never smokers undergoing CCRT. In a multivariate cox proportional hazard model adjusted for age, gender, and overall tumor stage, HPV + current smokers experienced nearly a fourfold increase in overall mortality in comparison to HPV + never/former smokers (HR = 3.68, 95% CI = 1.35‐10.0). Similarly, current smokers with HPV − tumors (HR = 6.80, 95% CI = 1.11‐41.67) had increased mortality compared to never/former smokers. Conclusions Current smoking is associated with poor prognosis, independent of HPV status, in CCRT‐treated OPSCC patients. Current smoking produced an approximately four‐ to sevenfold increase in risk of mortality for HPV + and HPV − patients, respectively. Regardless of pack years and HPV status, efforts should be made to achieve smoking cessation before CCRT. Level of Evidence 4. Laryngoscope , 126:2733–2738, 2016