TY - JOUR
T1 - Smoking and other patient factors in HPV-mediated oropharynx cancer
T2 - A retrospective cohort study
AU - Schostag, Kelly
AU - Lynch, Patrick T.
AU - Leavitt, Taylor
AU - Sumer, Baran D.
AU - Yang, Alex
AU - Shah, Avni
AU - Emmet, Thomas R.
AU - Sher, David J.
AU - Day, Andrew
N1 - Funding Information:
Financial: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the “National Institutes of Health” under award Number 1UL1TR003163-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Academic Information Systems, a division of Information Resources working with the UT Southwestern Center for Translational Medicine provided this research project with the following support: IRB approved data distribution from a centralized Research Data WarehouseFunding: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the “National Institutes of Health” under award Number 1UL1TR003163-01A1. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Academic Information Systems, a division of Information Resources working with the UT Southwestern Center for Translational Medicine provided this research project with the following support: IRB approved data distribution from a centralized Research Data Warehouse.
Funding Information:
Financial : Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the " National Institutes of Health " under award Number 1UL1TR003163-01A1 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Academic Information Systems, a division of Information Resources working with the UT Southwestern Center for Translational Medicine provided this research project with the following support: IRB approved data distribution from a centralized Research Data Warehouse
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/9/1
Y1 - 2022/9/1
N2 - Purpose: To characterize the significance of patient-level influences, including smoking history, on oncologic outcomes in human papillomavirus (HPV)-mediated oropharyngeal cancer (OPC). Materials and methods: A bi-institutional retrospective cohort study of previously untreated, HPV+ OPC patients who underwent curative treatment from 1/1/2008 to 7/1/2018 was performed. The primary outcome was disease-free survival (DFS) and the primary exposure was ≤10 versus >10-pack-year (PY)-smoking history. Results: Among 953 OPC patients identified, 342 individuals with HPV+ OPC were included. The median patient age was 62 years, 33.0% had a > 10-PY-smoking history, 60.2% had AJCC8 stage I disease, and 35.0% underwent primary surgery. The median follow-up was 49 months (interquartile range [IQR] 32–75 months). Four-year DFS-estimates were similar among patients with ≤10-PY-smoking history (78.0%, 95% CI:71.7%–83.1%) compared to >10-PYs (74.8%; 95% CI:65.2%–82.0%; log-rank:p = 0.53). On univariate analysis, >10-PY-smoking history did not correlate with DFS (hazard ratio[HR]:1.15;95% CI:0.74–1.79) and remained nonsignificant when forced into the multivariable model. On adjusted analyses, stage, treatment paradigm, and age predicted DFS. Neither >10-PYs, nor any other definition of tobacco use (e.g., current smoker or > 20-PYs) was predictive of DFS, overall survival, or disease-specific survival. Conversely, age nonsignificantly and significantly predicted adjusted DFS (adjusted HR[aHR]:1.02,95% CI:0.997–1.05, p = 0.08), overall survival (aHR 1.05; 95% CI: 1.02–1.08; p = 0.002) and disease-specific survival (aHR 1.04;95% CI: 0.99–1.09;p = 0.09). Conclusion: Other than age, patient-level influences may not be primary drivers of HPV+ OPC outcomes. Although limited by its modest sample size, our study suggests the significance of smoking has been overstated in this disease. These findings and the emerging literature collectively do not support risk-stratification employing the >10-PY threshold.
AB - Purpose: To characterize the significance of patient-level influences, including smoking history, on oncologic outcomes in human papillomavirus (HPV)-mediated oropharyngeal cancer (OPC). Materials and methods: A bi-institutional retrospective cohort study of previously untreated, HPV+ OPC patients who underwent curative treatment from 1/1/2008 to 7/1/2018 was performed. The primary outcome was disease-free survival (DFS) and the primary exposure was ≤10 versus >10-pack-year (PY)-smoking history. Results: Among 953 OPC patients identified, 342 individuals with HPV+ OPC were included. The median patient age was 62 years, 33.0% had a > 10-PY-smoking history, 60.2% had AJCC8 stage I disease, and 35.0% underwent primary surgery. The median follow-up was 49 months (interquartile range [IQR] 32–75 months). Four-year DFS-estimates were similar among patients with ≤10-PY-smoking history (78.0%, 95% CI:71.7%–83.1%) compared to >10-PYs (74.8%; 95% CI:65.2%–82.0%; log-rank:p = 0.53). On univariate analysis, >10-PY-smoking history did not correlate with DFS (hazard ratio[HR]:1.15;95% CI:0.74–1.79) and remained nonsignificant when forced into the multivariable model. On adjusted analyses, stage, treatment paradigm, and age predicted DFS. Neither >10-PYs, nor any other definition of tobacco use (e.g., current smoker or > 20-PYs) was predictive of DFS, overall survival, or disease-specific survival. Conversely, age nonsignificantly and significantly predicted adjusted DFS (adjusted HR[aHR]:1.02,95% CI:0.997–1.05, p = 0.08), overall survival (aHR 1.05; 95% CI: 1.02–1.08; p = 0.002) and disease-specific survival (aHR 1.04;95% CI: 0.99–1.09;p = 0.09). Conclusion: Other than age, patient-level influences may not be primary drivers of HPV+ OPC outcomes. Although limited by its modest sample size, our study suggests the significance of smoking has been overstated in this disease. These findings and the emerging literature collectively do not support risk-stratification employing the >10-PY threshold.
KW - Hpv-mediated oropharyngeal cancer
KW - Outcomes
KW - Patient-level influences
KW - Smoking
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U2 - 10.1016/j.amjoto.2022.103555
DO - 10.1016/j.amjoto.2022.103555
M3 - Article
C2 - 36037765
AN - SCOPUS:85136500568
SN - 0196-0709
VL - 43
JO - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
JF - American Journal of Otolaryngology - Head and Neck Medicine and Surgery
IS - 5
M1 - 103555
ER -