The association of smoking and outcomes in HPV-positive oropharyngeal cancer: A systematic review |
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| Affiliation: | 2. St. Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, United States;3. Department of Oncology, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21287, United States;4. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States;1. Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark;2. Department of Oncology, Aarhus University Hospital, Denmark;3. Department of Oncology, Odense University Hospital, Denmark;4. Department of Oncology, Rigshospitalet, Denmark;5. Department of Oncology, Herlev Hospital, Copenhagen, Denmark;6. Department of Oncology, Aalborg Hospital, Denmark;7. Department of Oncology, Oslo University Hospital, Norway;1. Department of Head and Neck Surgery, Institut de Cancérologie Gustave Roussy, Villejuif, France;2. Department of Virology, Faculty of Medicine University Pierre et Marie Curie Paris VI and Hospital Tenon Assistance Publique Hôpitaux de Paris, France;3. Department of Medical Oncology, Institut de Cancérologie Gustave Roussy, Villejuif, France;4. Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine University Pierre et Marie Curie Paris VI and Hospital Tenon Assistance Publique Hôpitaux de Paris, France;1. Albany Medical College, Albany, NY, USA;2. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, USA;3. Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA;4. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA;5. Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA;6. Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA;7. Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany;8. Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany;9. National Center for Tumor Diseases (NCT), Heidelberg, Germany;10. German Cancer Consortium (DKTK), Partner Site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, Germany;11. Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA |
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| Abstract: | PurposeWhile smoking is linked to worse outcomes for human papillomavirus (HPV)-related oropharyngeal squamous cell cancer (OPSCC), the magnitude of this association and the amount of smoking exposure necessary to confer clinically significant differences in outcomes is unclear. Recent studies suggested that greater tobacco exposure results in higher risk of cancer progression and death. Our study objective was to perform a systematic review of the association between smoking and HPV-related OPSCC outcomes.Materials and methodsA literature search was conducted in April 2019 to identify relevant articles using Embase, Medline, Scopus, CENTRAL, and Cochrane databases. All studies were independently screened by two investigators to identify studies that assessed HPV-positive patients as an independent cohort, specified smoking measures, and reported locoregional recurrence (LRR), overall survival (OS), disease-specific survival (DSS), or disease-free survival (DFS) in association with smoking.ResultsOf 1130 studies identified, 10 met final inclusion criteria with 2321 total patients, mean age 57.5 years. Smoking measures included ever vs never, current vs never/former smokers, ≤10 vs >10 pack-year, and continuous pack-years. Of these studies, 8 (80%) showed a significant effect of smoking on increasing recurrence and mortality. Adjusted HRs for LRR ranged from 0.6 to 5.2, OS from 1.3 to 4.0, DSS from 2.3 to 7.2, and DFS from 1.02 to 4.2 among heavier smokers compared to lighter/non-smokers.ConclusionsWhile there was significant variability in smoking metrics and reported outcomes, all studies reporting statistically significant HRs showed that smoking was associated with worse outcomes. Further studies using uniform smoking measures are necessary to better understand this association. |
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