Smoking and other patient factors in HPV-mediated oropharynx cancer: A retrospective cohort study

Schostag, Kelly; Lynch, Patrick M.; Leavitt, Taylor; Sumer, Baran D.; Yang, Alex; Shah, Avni; Emmet, Thomas Addis; Sher, David J.; Day, Andrew T.

doi:10.1016/j.amjoto.2022.103555

Cited by 7 publications

(11 citation statements)

References 65 publications

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“…In their 2022 study, Schostag and colleagues also found no smoking metrics to impact RFS. 6 Our work is also in agreement with a 2019 study finding that current and former smokers were not at an increased risk of either locoregional or distant recurrence after accounting for age and stage. 21 Importantly, recent analysis of the E3311 data found smoking to have no impact on outcomes in the trial cohort.…”

Section: Assessing the Impact Of Smoking Metrics On 3-year Recurrence...supporting

confidence: 92%

“…Other studies, however, have contended that the impact smoking has on HPV+ disease outcomes may be overstated. Recently, Schostag et al reported that smoking did not impact survival in a bi‐institutional, retrospective cohort, corroborating similar findings seen in other studies, including a recent analysis of E3311 data 6,7 …”

Section: Introductionsupporting

confidence: 75%

“…Recently, Schostag et al reported that smoking did not impact survival in a bi-institutional, retrospective cohort, corroborating similar findings seen in other studies, including a recent analysis of E3311 data. 6,7 In addition to the heterogeneity of study or trial inclusion criteria, this topic is further complicated by the variability in how tobacco use is reported in the current literature. Since the Ang et al analysis of the RTOG 0129 data, several studies have used a >10 PY history as a cutoff when discussing the impact of smoking on HPV+ OPSCC outcomes.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer

Wilkins,

Shah,

Safranek

et al. 2024

The Laryngoscope

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ObjectiveWhile tobacco use is understood to negatively impact HPV+ oropharyngeal squamous cell carcinoma (OPSCC) outcomes, debate remains as to how this impact differs between cohorts. Multiple smoking metrics have been identified as having the greatest prognostic significance, and some recent works have found smoking to have no significant impact. Herein, we show through an analysis of four common smoking metrics that while smoking impacts overall survival (OS), it has a limited impact on recurrence‐free survival (RFS) in our cohort.MethodsWe conducted a retrospective review of patients treated for HPV+ OPSCC in our health system from 2012 to 2019. Patients with metastatic disease or concurrent second primaries were excluded. Four metrics of tobacco use were assessed: current/former/never smokers, ever/never smokers, and smokers with >10 or >20 pack‐year (PY) smoking histories. Our main outcomes were 3‐year RFS and OS.ResultsThree hundred and sixty‐seven patients met inclusion criteria. 37.3% of patients (137/367) were never‐smokers; 13.8% of patients (51/367) were currently smoking at diagnosis and 48.8% of patients (179/367) were former smokers. No tobacco‐use metric significantly impacted 3‐year RFS. On univariate analysis, all smoking metrics yielded inferior OS. On multivariate analysis, current and ever smoking status significantly impacted 3‐year OS.ConclusionThe impact of tobacco use on HPV+ OPSCC outcomes is not universal, but may instead be modulated by other cohort‐specific factors. The impact of smoking may decrease as rates of tobacco use decline.Level of EvidenceIII (Cohort and case–control studies) Laryngoscope, 2024

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Section: Assessing the Impact Of Smoking Metrics On 3-year Recurrence...supporting

confidence: 92%

Section: Introductionsupporting

confidence: 75%

Section: Introductionmentioning

confidence: 99%

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The Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer

Wilkins,

Shah,

Safranek

et al. 2024

The Laryngoscope

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“…3,9,[16][17][18] Smoking may not worsen survival in HPV-positive oropharyngeal cancer but may increase the risk of tumor recurrence. 19,20 Viral etiology is known also for nasopharyngeal cancer which shows internationally endemic clustering in Southern Asia and Northern Africa and is often associated with Epstein-Barr virus positivity; the mortality difference between the highest (Malaysia) and lowest global mortality (Finland) is 50-fold. 3,21 We report here historical and up-to-date survival data for the selected HN cancers from Denmark (DK), Finland (FI), Norway (NO), and Sweden (SE) over a half century.…”

Section: Introductionmentioning

confidence: 99%

“…HPV etiology has also clinical implications as HPV‐positive oropharyngeal cancers are more responsive to treatment than HPV‐negative cancers and thus have a more favorable prognosis 3,9,16–18 . Smoking may not worsen survival in HPV‐positive oropharyngeal cancer but may increase the risk of tumor recurrence 19,20 . Viral etiology is known also for nasopharyngeal cancer which shows internationally endemic clustering in Southern Asia and Northern Africa and is often associated with Epstein–Barr virus positivity; the mortality difference between the highest (Malaysia) and lowest global mortality (Finland) is 50‐fold 3,21 …”

Section: Introductionmentioning

confidence: 99%

Survival in oral and pharyngeal cancers is catching up with laryngeal cancer in the NORDIC countries through a half century

Zitricky,

Koskinen,

Hemminki

et al. 2024

Cancer Medicine

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BackgroundCancers of the head and neck (HN) are heterogeneous tumors with incidence rates varying globally. In Northern Europe oral and oropharyngeal cancers are the most common individual types. Survival for HN varies by individual tumor type but for most of them survival trends are not well known over extended periods of time.MethodsData for a retrospective survival study were obtained for Danish, Finnish, Norwegian, and Swedish patients from the NORDCAN database from 1971 to 2020. Relative 1‐ and 5‐year survival rates and 5/1‐year conditional survival for years 2–5 were calculated.ResultsBoth 1‐ and 5‐year survival improved for all HN cancers but only marginally for laryngeal cancer. For the other cancers a 50‐year increase in 5‐year survival was about 30% units for nasopharyngeal and oropharyngeal cancers, 20% units for oral cancer and somewhat less for hypopharyngeal cancer.Conclusions5‐year survival reached about 65% for all HN cancers, except for hypopharyngeal cancer (30%). Human papilloma virus infection is becoming a dominant risk factor for the rapidly increasing oropharyngeal cancer, the prevention of which needs to emphasize oral sex as a route of infection.

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Prognostic Significance of the Microenvironment in Human Papillomavirus Oropharyngeal Carcinoma: A Systematic Review

Baudouin,

Hans,

Lisan

et al. 2023

The Laryngoscope

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ObjectiveThe immune microenvironment of HPV‐associated (HPV+) oropharyngeal squamous cell carcinomas (OPSCCs) (HPV+OPSCCs) differs from that of HPV‐independent oropharyngeal cancers (HPV‐independent OPSCCs). The literature on the subject is very abundant, demanding an organized synthesis of this wealth of information to evaluate the hypothesis associating the favorable prognosis of HPV+OPSCC patients with a different immune microenvironment. A systematic review of the literature was conducted regarding the microenvironment of HPV+OPSCCs.Data SourceMEDLINE/PubMed, Embase, and Cochrane Library databases.Review MethodsA literature search was performed following PRISMA guidelines (Moher D. PLoS Med. 2009). The PEO (Population, Exposure, and Outcome) framework is detailed as follows: P: patients with oropharyngeal squamous cell carcinomas, E: human papillomavirus (HPV), and O: histological and immunological composition of the tumoral microenvironment (TME). No meta‐analysis was performed.ResultsFrom 1,202 studies that were screened, 58 studies were included (n = 6,474 patients; n = 3,581 (55%) HPV+OPSCCs and n = 2,861(45%) HPV‐independent OPSCCs). The presence of tumor‐infiltrating lymphocytes (TIL), CD3+ in 1,733 patients, CD4+ in 520 patients, and CD8+ (cytotoxic T lymphocytes (CTL)) in 3,104 patients, and high levels of PD‐L1 expression in 1,222 patients is strongly correlated with an improved clinical outcome in HPV+OPSCCs.ConclusionThis systematic review provides the most comprehensive information on the immune microenvironment of HPV+OPSCCs to date. Tumor‐infiltrating lymphocytes and PD‐L1 expression are associated with a favorable prognosis. B, CD8+ and resident memory cells densities are higher in HPV+OPSCCs. The importance of myeloid lineages is still a matter of debate and research.Level of EvidenceN/A Laryngoscope, 2023

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Smoking and other patient factors in HPV-mediated oropharynx cancer: A retrospective cohort study

Cited by 7 publications

References 65 publications

The Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer

The Impact of Four Smoking Metrics on Survival After Diagnosis with HPV+ Oropharyngeal Cancer

Survival in oral and pharyngeal cancers is catching up with laryngeal cancer in the NORDIC countries through a half century

Prognostic Significance of the Microenvironment in Human Papillomavirus Oropharyngeal Carcinoma: A Systematic Review

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