Impact on survival of tobacco smoking for cases with oropharyngeal squamous cell carcinoma and known human papillomavirus and p16-status: a multicenter retrospective study
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Christian Grønhøj1, Jakob Schmidt Jensen1, Steffen Wagner2, Christian Dehlendorff3, Jeppe Friborg4, Elo Andersen5, Claus Wittekindt2, Nora Würdemann2,6, Shachi Jenny Sharma2,6, Stefan Gattenlöhner7, Jens Peter Klussmann2,6 and Christian von Buchwald1
1 Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
2 Department of Otorhinolaryngology, Head and Neck Surgery, University of Giessen, Giessen, Germany
3 Department of Statistics and Pharmacoepidemiology, Danish Cancer Society Research Center, Copenhagen, Denmark
4 Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
5 Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
6 Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
7 Department of Pathology, University of Giessen, Giessen, Germany
Keywords: oropharyngeal cancer; human papillomavirus; smoking; survival
Received: May 01, 2019 Accepted: June 29, 2019 Published: July 23, 2019
Human papilloma virus (HPV) and tobacco smoking are important risk factors for development of oropharyngeal squamous cell carcinoma (OPSCC).
To evaluate the impact of tobacco smoking on survival for cases with OPSCC with known HPV- and p16INK4A(p16)-status.
Materials and Methods
OPSCC cases at the University Hospital of Copenhagen, Rigshospitalet, Denmark (2000–2014) and at University Hospital of Giessen, Germany (2000–2009) were included. Survival was illustrated with Kaplan-Meier plots. The effect of smoking exposure on survival was evaluated by Cox-regression models. HPV-positivity was defined as positivity for both HPV-DNA and p16.
We included 1316 OPSCC cases from 2000–2014 (48% HPV-positive). Smokers had a poorer outcome compared to non-smokers. Considering continuous smoking exposure, adding 10 pack-years of smoking increased hazard ratios irrespective of HPV-status.
We observed a tendency to a greater impact on survival for cases with HPV-neg. tumours compared to cases with HPV-pos. tumours at low numbers of pack-years, yet the survival was similar at high numbers of pack-years. There was no significant difference in the impact of HPV-status on survival for non-smokers, however a highly significant difference for smokers.
Conclusions and Significance
Smoking-status and number of pack-years at time of diagnosis impact survival for cases with OPSCC independent of HPV-status.
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