Impact of active smoking on outcomes in HPV+ oropharyngeal cancer
Roy Xiao MD, MS
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
Search for more papers by this authorYvonne Pham MD
Department of Radiation Oncology, Research Medical Center, Therapeutic Radiologists, Inc., Kansas City, Missouri
Search for more papers by this authorMatthew C. Ward MD
Southeast Radiation Oncology Group, Charlotte, North Carolina
Search for more papers by this authorNarcissa Houston MHA
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorChandana A. Reddy MS
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorNikhil P. Joshi MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJohn F. Greskovich Jr MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Florida, Weston, Florida
Search for more papers by this authorNeil M. Woody MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorDeborah J. Chute MD
Department of Anatomic Pathology, Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorEric D. Lamarre MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorBrandon L. Prendes MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorRobert R. Lorenz MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJoseph Scharpf MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorBrian B. Burkey MD, MEd
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJessica L. Geiger MD
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorDavid J. Adelstein MD
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorCorresponding Author
Shlomo A. Koyfman MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Correspondence
Shlomo A. Koyfman, MD, Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, CA-50, Cleveland, Ohio 44195.
Email: [email protected]
Search for more papers by this authorRoy Xiao MD, MS
Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts
Search for more papers by this authorYvonne Pham MD
Department of Radiation Oncology, Research Medical Center, Therapeutic Radiologists, Inc., Kansas City, Missouri
Search for more papers by this authorMatthew C. Ward MD
Southeast Radiation Oncology Group, Charlotte, North Carolina
Search for more papers by this authorNarcissa Houston MHA
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorChandana A. Reddy MS
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorNikhil P. Joshi MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJohn F. Greskovich Jr MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Florida, Weston, Florida
Search for more papers by this authorNeil M. Woody MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorDeborah J. Chute MD
Department of Anatomic Pathology, Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorEric D. Lamarre MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorBrandon L. Prendes MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorRobert R. Lorenz MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJoseph Scharpf MD
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorBrian B. Burkey MD, MEd
Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorJessica L. Geiger MD
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorDavid J. Adelstein MD
Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Search for more papers by this authorCorresponding Author
Shlomo A. Koyfman MD
Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
Correspondence
Shlomo A. Koyfman, MD, Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue, CA-50, Cleveland, Ohio 44195.
Email: [email protected]
Search for more papers by this authorAbstract
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.
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