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Prognostic Significance of Smoking in Human Papillomavirus– Positive Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage
Author(s) -
Chidambaram Smrithi,
Nakken Erik R.,
Kennedy William,
Thorstad Wade L.,
Chen Stephanie Y.,
Pipkorn Patrik,
Zevallos Jose P.,
Mazul Angela L.
Publication year - 2020
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.28659
Subject(s) - medicine , hazard ratio , stage (stratigraphy) , proportional hazards model , cancer , confidence interval , oncology , human papillomavirus , ajcc staging system , retrospective cohort study , cohort , paleontology , biology , staging system
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