Impact of Smoking on the Survival of Patients With High-risk HPV-positive HNSCC: A Meta-analysis

High risk Human papillomavirus (hr-HPV) and smoking are independant risk factors for head and neck squamous cell carcinomas (HNSCC). While hr-HPV HNSCC has a better prognosis than smoking-associated HNSCC no systematic data are yet available about the combined risk. We performed a meta-analysis to assess the overall survival of HNSCC patients relative to the hr-HPV and smoking status. A literature review up to November 2019 was conducted in PubMed and Cochrane Library using the search terms 'HPV, Smoking and HNSCC'. Nine out of 748 articles were included, 1,436 out of 2,080 patients were hr-HPV The prevalence of hr-HPV smokers was 36%. The meta-analysis showed a significantly better 5-year overall survival for HPV non-smokers compared to smokers with risk ratio of 1.94 (95% confidence intervaI=1.46-2.58). Smoking is a negative prognostic factor for overall survival in patients with hr-HPV HNSCC and should thus be an important part of staging and treatment.