Impact of American Joint Committee on Cancer Eighth Edition clinical stage and smoking history on oncologic outcomes in human papillomavirus‐associated oropharyngeal squamous cell carcinoma

Abstract

Background The purpose of this study was to evaluate the AJCC eighth edition clinical staging system for human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma and to further understand how clinical stage and smoking history affect oncologic outcomes. The purpose of this study was to present the understanding of how clinical stage and smoking history affect oncologic outcomes in human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma (SCC) is critical for selecting patients for treatment deintensification. Methods Kaplan‐Meier and Cox regression were used to evaluate overall survival (OS), locoregional recurrence‐free survival (LRFS), and distant recurrence‐free survival (DRFS). Concordance statistics (C‐indices) were used to compare discriminating ability. Results The OS and DRFS but not LRFS were significantly distributed using the American Joint Committee on Cancer (AJCC) seventh and eighth editions criteria. The C‐indices for OS, LRFS, and DRFS were 0.57, 0.54, and 0.60, respectively, using the AJCC seventh edition, and 0.63, 0.53, and 0.65, respectively, using the AJCC eighth edition. On multivariate analysis, 1 + pack‐year smoking history correlated with OS (hazard ratio [HR] 1.96; 95% confidence interval [CI] 1.2‐3.1; P < .01) but not LRFS or DRFS. Conclusion These results support implementation of the AJCC eighth edition for HPV‐associated oropharyngeal SCC. Clinical stage may be more important than smoking history in selection for deintensification.

Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery

“…There have been many additional studies over the past decade analyzing the relationship between smoking and outcomes for HPV‐positive patients with OPSCC . To the best of our knowledge, the largest study to date included 1875 patients from Canada and Denmark, all of whom were treated nonsurgically.…”

“…The combined analysis of both trials demonstrated that the low‐risk group had more favorable outcomes than the intermediate‐risk group (5‐year OS rate: 87.9% vs 66.4% [ P < .001]; and 5‐year progression‐free survival rate: 76.4% vs 53.6% [ P < .001]). However, the data were not unanimous because another large recent study (531 patients) found smoking to significantly impact OS but not locoregional failure (hazard ratio, 1.21; P = .95) …”

“…This literature is summarized in Table . All the studies in Table were composed of patient cohorts that were treated with definitive chemoradiation. To the best of our knowledge, there is a paucity of literature regarding the impact of smoking on patients who are treated surgically, which motivated the design and analysis of our TORS cohort study.…”

“…To the best of our knowledge, there is a paucity of literature regarding the impact of smoking on patients who are treated surgically, which motivated the design and analysis of our TORS cohort study. Table shows that smoking history is very common in patients with HPV‐positive OPSCC. Many studies have demonstrated that smoking does have an impact on OS in patients who are treated nonsurgically and likely has an impact on disease‐specific outcomes such as RFS, locoregional control, and DSS.…”

“…Many studies have demonstrated that smoking does have an impact on OS in patients who are treated nonsurgically and likely has an impact on disease‐specific outcomes such as RFS, locoregional control, and DSS. To the best of our knowledge, the majority of studies have found an impact of smoking on disease‐specific outcomes, although some have not . Controversy regarding the relationship between smoking and disease‐specific outcomes continues and further research is needed.…”