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
Fixation of subtrochanteric femur fractures using intramedullary nails can provide high rates of osseous union. However, a lateral starting point or a medial trajectory can result in varus alignment, typically seen with trochanteric entry nails. Even with piriformis nails, medial comminution can result in secondary malalignment and varus. Varus can predictably result in nonunion and need for repeat operations. Medialized trochanteric entry nailing has been reported previously as a method to prevent varus alignment in low-energy, atypical subtrochanteric femur fractures in association with bisphosphonate use. We present a surgical technique using a medialized trochanteric nail entry point to provide proper alignment and avoidance of varus malreduction in 24 patients with a subtrochanteric femur fracture after a high-energy traumatic event.
Background
Although strongly associated with tobacco and alcohol use, many oral cavity squamous cell carcinoma (OCSCC) cases occur in patients without exposure to either, known as “never‐smoker, never‐drinkers” (NSND). We aimed to compare clinical outcomes between NSND and tobacco/alcohol‐exposed populations and to define demographic characteristics of NSND.
Methods
We performed a retrospective, single‐institution cohort study of 672 OCSCC patients. Cox models were used to estimate differences in overall survival (OS) and recurrence‐free survival (RFS) between NSND and tobacco/alcohol‐exposed patients while adjusting for confounders.
Results
NSND represented 25.6% of our cohort and were older, more female, and more economically advantaged. Among NSND, oral tongue tumors dominated in younger patients, while alveolar ridge tumors dominated in elderly patients. Multivariate survival analysis revealed no differences in OS or RFS between NSND and tobacco/alcohol‐exposed patients.
Conclusion
When adjusted for independent biologic features, clinical outcomes in OCSCC are similar between NSND and tobacco/alcohol‐exposed patients.
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