Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery
Background When treated nonsurgically with definitive chemoradiation, smokers with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) have a worse prognosis compared with their nonsmoking counterparts. To the authors' knowledge, the prognostic significance of smok...
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| Veröffentlicht in: | Cancer 2020-01, Vol.126 (9), p.1873-1887 |
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| creator | Roden, Dylan F. Hobelmann, Kealan Vimawala, Swar Richa, Tony Fundakowski, Christopher E. Goldman, Richard Luginbuhl, Adam Curry, Joseph M. Cognetti, David M. |
| description | Background
When treated nonsurgically with definitive chemoradiation, smokers with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) have a worse prognosis compared with their nonsmoking counterparts. To the authors' knowledge, the prognostic significance of smoking in surgically treated patients is unknown.
Methods
The current study is a retrospective case series of patients with HPV‐positive OPSCC who underwent upfront transoral robotic surgery at a single institution from 2010 through 2017. Exclusion criteria were nonoropharyngeal primary tumors, histology other than SCC, HPV‐negative tumors, previous history of head and neck cancer, and/or previous head and neck radiotherapy. Recurrence‐free survival (RFS), overall survival, and disease‐specific survival were compared using the Kaplan‐Meier method and the log‐rank test. Smoking history was categorized as never smokers ( |
| doi_str_mv | 10.1002/cncr.32739 |
| format | Article |
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When treated nonsurgically with definitive chemoradiation, smokers with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) have a worse prognosis compared with their nonsmoking counterparts. To the authors' knowledge, the prognostic significance of smoking in surgically treated patients is unknown.
Methods
The current study is a retrospective case series of patients with HPV‐positive OPSCC who underwent upfront transoral robotic surgery at a single institution from 2010 through 2017. Exclusion criteria were nonoropharyngeal primary tumors, histology other than SCC, HPV‐negative tumors, previous history of head and neck cancer, and/or previous head and neck radiotherapy. Recurrence‐free survival (RFS), overall survival, and disease‐specific survival were compared using the Kaplan‐Meier method and the log‐rank test. Smoking history was categorized as never smokers (<1 pack‐year), current smokers (smoking at the time of the cancer diagnosis), and former smokers.
Results
A total of 258 patients met the study criteria. The average age was 60 years, and approximately 87% of patients were male. A total of 148 patients (57.4%) were smokers whereas 110 (42.6%) reported never smoking. There were 44 active smokers (17.1%) and 104 former smokers (40.3%). The median follow‐up was 3.23 years. There were 17 patients of disease recurrence. Smoking pack‐year history was not found to be significant for RFS (hazard ratio, 1.01; 95% CI, 0.99‐1.03 [P = .45]). There was no significant difference in RFS noted between never and ever smokers (92% vs 89.8%; P = .85) nor was there a difference observed between never, former, and current smokers (92% vs 91.5% vs 86.1%, respectively; P = .69).
Conclusions
A smoking history is common in patients with HPV‐positive OPSCC. In the current study, HPV‐positive smokers were found to have excellent survival and locoregional control, similar to their nonsmoking counterparts. The results of the current study do not support the exclusion of smokers with early‐stage, HPV‐positive OPSCC from transoral robotic surgery–based deintensification trials.
Contrary to what has been published in the literature regarding the negative prognostic impact of smoking on survival outcomes among patients with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) who are treated with nonsurgical definitive therapy, smoking does not appear to significantly impact recurrence‐free survival in patients with HPV‐positive OPSCC who are treated with upfront transoral robotic surgery (TORS) followed by pathology‐directed adjuvant therapy. These data do not support the exclusion of smokers from prospective TORS‐based deintensification trials.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.32739</identifier><identifier>PMID: 32032441</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Cancer ; Chemoradiotherapy ; Clinical trials ; Cyclin-Dependent Kinase Inhibitor p16 - metabolism ; Female ; Head & neck cancer ; head and neck cancer ; Histology ; HPV positive ; Human papillomavirus ; human papillomavirus (HPV) ; Humans ; Male ; Medical prognosis ; Middle Aged ; Oncology ; Oral Surgical Procedures - instrumentation ; Oropharyngeal cancer ; Oropharyngeal Neoplasms - surgery ; Oropharyngeal Neoplasms - virology ; oropharynx ; Papillomavirus Infections - surgery ; Radiation therapy ; Rank tests ; Retrospective Studies ; Robotic surgery ; Robotic Surgical Procedures - adverse effects ; Smoking ; Smoking - epidemiology ; Squamous cell carcinoma ; Surgery ; Survival ; Survival Analysis ; Throat cancer ; transoral robotic surgery (TORS) ; Tumors</subject><ispartof>Cancer, 2020-01, Vol.126 (9), p.1873-1887</ispartof><rights>2020 American Cancer Society</rights><rights>2020 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3939-e20d356964290706e465b8bb9d6ff91ca28f96dd90b0f6065e7816e6b1f993213</citedby><cites>FETCH-LOGICAL-c3939-e20d356964290706e465b8bb9d6ff91ca28f96dd90b0f6065e7816e6b1f993213</cites><orcidid>0000-0003-1476-4573 ; 0000-0001-8031-8956</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.32739$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.32739$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1416,1432,27923,27924,45573,45574,46408,46832</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32032441$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Roden, Dylan F.</creatorcontrib><creatorcontrib>Hobelmann, Kealan</creatorcontrib><creatorcontrib>Vimawala, Swar</creatorcontrib><creatorcontrib>Richa, Tony</creatorcontrib><creatorcontrib>Fundakowski, Christopher E.</creatorcontrib><creatorcontrib>Goldman, Richard</creatorcontrib><creatorcontrib>Luginbuhl, Adam</creatorcontrib><creatorcontrib>Curry, Joseph M.</creatorcontrib><creatorcontrib>Cognetti, David M.</creatorcontrib><title>Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery</title><title>Cancer</title><addtitle>Cancer</addtitle><description>Background
When treated nonsurgically with definitive chemoradiation, smokers with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) have a worse prognosis compared with their nonsmoking counterparts. To the authors' knowledge, the prognostic significance of smoking in surgically treated patients is unknown.
Methods
The current study is a retrospective case series of patients with HPV‐positive OPSCC who underwent upfront transoral robotic surgery at a single institution from 2010 through 2017. Exclusion criteria were nonoropharyngeal primary tumors, histology other than SCC, HPV‐negative tumors, previous history of head and neck cancer, and/or previous head and neck radiotherapy. Recurrence‐free survival (RFS), overall survival, and disease‐specific survival were compared using the Kaplan‐Meier method and the log‐rank test. Smoking history was categorized as never smokers (<1 pack‐year), current smokers (smoking at the time of the cancer diagnosis), and former smokers.
Results
A total of 258 patients met the study criteria. The average age was 60 years, and approximately 87% of patients were male. A total of 148 patients (57.4%) were smokers whereas 110 (42.6%) reported never smoking. There were 44 active smokers (17.1%) and 104 former smokers (40.3%). The median follow‐up was 3.23 years. There were 17 patients of disease recurrence. Smoking pack‐year history was not found to be significant for RFS (hazard ratio, 1.01; 95% CI, 0.99‐1.03 [P = .45]). There was no significant difference in RFS noted between never and ever smokers (92% vs 89.8%; P = .85) nor was there a difference observed between never, former, and current smokers (92% vs 91.5% vs 86.1%, respectively; P = .69).
Conclusions
A smoking history is common in patients with HPV‐positive OPSCC. In the current study, HPV‐positive smokers were found to have excellent survival and locoregional control, similar to their nonsmoking counterparts. The results of the current study do not support the exclusion of smokers with early‐stage, HPV‐positive OPSCC from transoral robotic surgery–based deintensification trials.
Contrary to what has been published in the literature regarding the negative prognostic impact of smoking on survival outcomes among patients with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) who are treated with nonsurgical definitive therapy, smoking does not appear to significantly impact recurrence‐free survival in patients with HPV‐positive OPSCC who are treated with upfront transoral robotic surgery (TORS) followed by pathology‐directed adjuvant therapy. These data do not support the exclusion of smokers from prospective TORS‐based deintensification trials.</description><subject>Aged</subject><subject>Cancer</subject><subject>Chemoradiotherapy</subject><subject>Clinical trials</subject><subject>Cyclin-Dependent Kinase Inhibitor p16 - metabolism</subject><subject>Female</subject><subject>Head & neck cancer</subject><subject>head and neck cancer</subject><subject>Histology</subject><subject>HPV positive</subject><subject>Human papillomavirus</subject><subject>human papillomavirus (HPV)</subject><subject>Humans</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Oral Surgical Procedures - instrumentation</subject><subject>Oropharyngeal cancer</subject><subject>Oropharyngeal Neoplasms - surgery</subject><subject>Oropharyngeal Neoplasms - virology</subject><subject>oropharynx</subject><subject>Papillomavirus Infections - surgery</subject><subject>Radiation therapy</subject><subject>Rank tests</subject><subject>Retrospective Studies</subject><subject>Robotic surgery</subject><subject>Robotic Surgical Procedures - adverse effects</subject><subject>Smoking</subject><subject>Smoking - epidemiology</subject><subject>Squamous cell carcinoma</subject><subject>Surgery</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Throat cancer</subject><subject>transoral robotic surgery (TORS)</subject><subject>Tumors</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kctu1DAUhi0EotPChgdAltigSim-JE68RKNykSqQEEjsIsc5mXFJ7ODLVLPrIyDxMLxPnwTPpLBgwco653z-bJ0foWeUXFBC2Ctttb_grObyAVpRIuuC0JI9RCtCSFNUJf96gk5DuM5lzSr-GJ1wRjgrS7pCvy53akwqGrvBcQvYTLPSEbsBh8l9O3Sdxb0JoALc3f4IM2gzGI1D8juTr2KXonYTBGwsnrMHbAz4xsQt3qZJHXqzGUc3qZ3xKdzd_lQhOG1UhB477-at8nu7gWzSymrwOHo4Do-O6JUNzuepd52Ly8Mb8Psn6NGgxgBP788z9OXN5ef1u-Lq49v369dXheaSywIY6XklpCiZJDURUIqqa7pO9mIYJNWKNYMUfS9JRwZBRAV1QwWIjg5Sckb5GXq5eGfvvicIsZ1M0DCOyoJLoWW8YllesTKjL_5Br13yNv8uU42kTU1qkanzhdLeheBhaGdvpryElpL2EGd7iLM9xpnh5_fK1E3Q_0X_5JcBugA3ZoT9f1Tt-sP60yL9DdX_sWo</recordid><startdate>20200101</startdate><enddate>20200101</enddate><creator>Roden, Dylan F.</creator><creator>Hobelmann, Kealan</creator><creator>Vimawala, Swar</creator><creator>Richa, Tony</creator><creator>Fundakowski, Christopher E.</creator><creator>Goldman, Richard</creator><creator>Luginbuhl, Adam</creator><creator>Curry, Joseph M.</creator><creator>Cognetti, David M.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TO</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1476-4573</orcidid><orcidid>https://orcid.org/0000-0001-8031-8956</orcidid></search><sort><creationdate>20200101</creationdate><title>Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery</title><author>Roden, Dylan F. ; Hobelmann, Kealan ; Vimawala, Swar ; Richa, Tony ; Fundakowski, Christopher E. ; Goldman, Richard ; Luginbuhl, Adam ; Curry, Joseph M. ; Cognetti, David M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3939-e20d356964290706e465b8bb9d6ff91ca28f96dd90b0f6065e7816e6b1f993213</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Cancer</topic><topic>Chemoradiotherapy</topic><topic>Clinical trials</topic><topic>Cyclin-Dependent Kinase Inhibitor p16 - metabolism</topic><topic>Female</topic><topic>Head & neck cancer</topic><topic>head and neck cancer</topic><topic>Histology</topic><topic>HPV positive</topic><topic>Human papillomavirus</topic><topic>human papillomavirus (HPV)</topic><topic>Humans</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Oral Surgical Procedures - instrumentation</topic><topic>Oropharyngeal cancer</topic><topic>Oropharyngeal Neoplasms - surgery</topic><topic>Oropharyngeal Neoplasms - virology</topic><topic>oropharynx</topic><topic>Papillomavirus Infections - surgery</topic><topic>Radiation therapy</topic><topic>Rank tests</topic><topic>Retrospective Studies</topic><topic>Robotic surgery</topic><topic>Robotic Surgical Procedures - adverse effects</topic><topic>Smoking</topic><topic>Smoking - epidemiology</topic><topic>Squamous cell carcinoma</topic><topic>Surgery</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Throat cancer</topic><topic>transoral robotic surgery (TORS)</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Roden, Dylan F.</creatorcontrib><creatorcontrib>Hobelmann, Kealan</creatorcontrib><creatorcontrib>Vimawala, Swar</creatorcontrib><creatorcontrib>Richa, Tony</creatorcontrib><creatorcontrib>Fundakowski, Christopher E.</creatorcontrib><creatorcontrib>Goldman, Richard</creatorcontrib><creatorcontrib>Luginbuhl, Adam</creatorcontrib><creatorcontrib>Curry, Joseph M.</creatorcontrib><creatorcontrib>Cognetti, David M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Roden, Dylan F.</au><au>Hobelmann, Kealan</au><au>Vimawala, Swar</au><au>Richa, Tony</au><au>Fundakowski, Christopher E.</au><au>Goldman, Richard</au><au>Luginbuhl, Adam</au><au>Curry, Joseph M.</au><au>Cognetti, David M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2020-01-01</date><risdate>2020</risdate><volume>126</volume><issue>9</issue><spage>1873</spage><epage>1887</epage><pages>1873-1887</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><abstract>Background
When treated nonsurgically with definitive chemoradiation, smokers with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) have a worse prognosis compared with their nonsmoking counterparts. To the authors' knowledge, the prognostic significance of smoking in surgically treated patients is unknown.
Methods
The current study is a retrospective case series of patients with HPV‐positive OPSCC who underwent upfront transoral robotic surgery at a single institution from 2010 through 2017. Exclusion criteria were nonoropharyngeal primary tumors, histology other than SCC, HPV‐negative tumors, previous history of head and neck cancer, and/or previous head and neck radiotherapy. Recurrence‐free survival (RFS), overall survival, and disease‐specific survival were compared using the Kaplan‐Meier method and the log‐rank test. Smoking history was categorized as never smokers (<1 pack‐year), current smokers (smoking at the time of the cancer diagnosis), and former smokers.
Results
A total of 258 patients met the study criteria. The average age was 60 years, and approximately 87% of patients were male. A total of 148 patients (57.4%) were smokers whereas 110 (42.6%) reported never smoking. There were 44 active smokers (17.1%) and 104 former smokers (40.3%). The median follow‐up was 3.23 years. There were 17 patients of disease recurrence. Smoking pack‐year history was not found to be significant for RFS (hazard ratio, 1.01; 95% CI, 0.99‐1.03 [P = .45]). There was no significant difference in RFS noted between never and ever smokers (92% vs 89.8%; P = .85) nor was there a difference observed between never, former, and current smokers (92% vs 91.5% vs 86.1%, respectively; P = .69).
Conclusions
A smoking history is common in patients with HPV‐positive OPSCC. In the current study, HPV‐positive smokers were found to have excellent survival and locoregional control, similar to their nonsmoking counterparts. The results of the current study do not support the exclusion of smokers with early‐stage, HPV‐positive OPSCC from transoral robotic surgery–based deintensification trials.
Contrary to what has been published in the literature regarding the negative prognostic impact of smoking on survival outcomes among patients with human papillomavirus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC) who are treated with nonsurgical definitive therapy, smoking does not appear to significantly impact recurrence‐free survival in patients with HPV‐positive OPSCC who are treated with upfront transoral robotic surgery (TORS) followed by pathology‐directed adjuvant therapy. These data do not support the exclusion of smokers from prospective TORS‐based deintensification trials.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32032441</pmid><doi>10.1002/cncr.32739</doi><tpages>19</tpages><orcidid>https://orcid.org/0000-0003-1476-4573</orcidid><orcidid>https://orcid.org/0000-0001-8031-8956</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Wiley Free Content; Wiley Online Library All Journals; Alma/SFX Local Collection |
| subjects | Aged Cancer Chemoradiotherapy Clinical trials Cyclin-Dependent Kinase Inhibitor p16 - metabolism Female Head & neck cancer head and neck cancer Histology HPV positive Human papillomavirus human papillomavirus (HPV) Humans Male Medical prognosis Middle Aged Oncology Oral Surgical Procedures - instrumentation Oropharyngeal cancer Oropharyngeal Neoplasms - surgery Oropharyngeal Neoplasms - virology oropharynx Papillomavirus Infections - surgery Radiation therapy Rank tests Retrospective Studies Robotic surgery Robotic Surgical Procedures - adverse effects Smoking Smoking - epidemiology Squamous cell carcinoma Surgery Survival Survival Analysis Throat cancer transoral robotic surgery (TORS) Tumors |
| title | Evaluating the impact of smoking on disease‐specific survival outcomes in patients with human papillomavirus–associated oropharyngeal cancer treated with transoral robotic surgery |
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