Impact of human papillomavirus and smoking on survival outcomes after transoral robotic surgery

Stucken, Chaz L.; Almeida, John R. de; Sikora, Andrew G.; Tong, Charles; Genden, Eric M.

doi:10.1002/hed.23915

Cited by 17 publications

(17 citation statements)

References 27 publications

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“…Only 28.2% required trimodality therapy (TORS followed by adjuvant CRT), which is less than the percentage of patients requiring trimodality therapy in some prior studies (43%−62%). 7,8,23,24 The relatively low frequency of trimodality therapy in our study population may partially explain the lower gastrostomy prevalence in the TORS group compared with the nonsurgical group, because the use of CRT is known to have adverse effects on swallowing function. 20 Although fewer patients undergoing TORS in our study received trimodality therapy compared with some prior studies, their survival was not inferior to that of patients undergoing RT/CRT in this matched analysis.…”

Section: Discussionmentioning

confidence: 92%

Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Sharma

Patel

Baik

et al. 2016

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Treatment of oropharyngeal squamous cell carcinoma (OPSCC) presents unique challenges and can be associated with significant morbidity. Transoral robotic surgery (TORS) has emerged as a treatment modality for OPSCC, but data comparing outcomes between patients treated with TORS-based therapy and nonsurgical therapy are limited. OBJECTIVE To compare survival and gastrostomy prevalence between patients with OPSCC treated with TORS-based therapy and those treated with nonsurgical therapy. DESIGN, SETTING, AND PARTICIPANTS This retrospective matched-cohort study identified patients with OPSCC treated at the University of Washington and University of Minnesota tertiary care medical centers from January 1, 2005, to December 31, 2013. Each patient treated with TORS-based therapy was matched by stage with as many as 3 patients treated with nonsurgical therapy. Final follow-up was completed on April 1, 2015. MAIN OUTCOMES AND MEASURES Disease-free survival, overall survival, and gastrostomy tube prevalence. RESULTS One hundred twenty-seven patients met the study criteria (113 men [89.0%];14 women [11.0%]; median [interquartile range] age, 57 [52–63] years); 39 patients who underwent TORS were matched to 88 patients who underwent nonsurgical therapy. Compared with the nonsurgical group, more patients had p16-positive tumors in the TORS group (30 of 31 [96.8%] vs 30 of 37 [81.1%] among patients with known p16 status). No statistically significant difference in survival between treatment groups was found in multivariable analysis (disease-free survival hazard ratio, 0.22; 95% CI, 0.04–1.36; P = .10). Patients who received TORS-based therapy had lower gastrostomy tube prevalence after treatment (13 of 39 [33.3%] vs 74 of 88 [84.1%]) for a univariable relative risk of 0.43 (95% CI, 0.27–0.67; P < .001) and a multivariable relative risk of 0.43 (95% CI, 0.27–0.68; P < .001). Gastrostomy prevalence decreased by time after treatment for both groups (TORS group:3 of 34 [9%] at 3 months to 1 of 33 [3%] at 12 months; nonsurgical group: 37 of 82 [45%] at3 months to 7 of 66 [11%] at 12 months). CONCLUSIONS AND RELEVANCE Patients undergoing TORS for OPSCC have statistically indistinguishable survival but lower gastrostomy prevalence compared with patients undergoing nonsurgical therapy for stage-matched OPSCC. TORS offers promise for improved swallowing function in patients with OPSCC.

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Section: Discussionmentioning

confidence: 92%

Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Sharma

Patel

Baik

et al. 2016

JAMA Otolaryngol Head Neck Surg

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“…Similarly, in a cohort study of patients undergoing transoral robotic surgery who were HPV1, smoking was not found to affect rates of locoregional control, OS, or PFS. 27 In a multi-institutional study examining transoral robotic surgery outcomes in head and neck cancer, multivariate analysis did not identify smoking as a risk factor for disease recurrence. 28 In contrast, our data demonstrated a 2.8-times increased risk of disease recurrence in ever smokers for surgically treated patients.…”

Section: Discussionmentioning

confidence: 98%

Impact of Smoking on Survival Outcomes in HPV‐Related Oropharyngeal Carcinoma: A Meta‐analysis

Ference

Liao

Gao

et al. 2020

Otolaryngol.--head neck surg.

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Objective Characterize the survival impact of smoking on HPV-related (human papillomavirus) oropharyngeal squamous cell carcinoma. Data Sources Articles from 2000 to 2019 in the PubMed, Embase, and Cochrane Library databases were systematically reviewed for content and inclusion/exclusion criteria. Review Methods Two reviewers independently analyzed the databases for eligibility and quality of the articles. Demographic data, smoking history, and survival outcomes were recorded. Hazard ratios and 95% CIs were collectively analyzed through a random effects meta-analysis model. Results Fifteen articles were included in the meta-analysis for overall survival, disease-specific survival, disease-free survival, progression-free survival, and locoregional recurrence outcomes. The overall survival hazard ratio was 2.4 for ever having smoked (95% CI, 1.4-4.0; P = .0006, I2 = .384) and 3.2 for current smoking (95% CI, 2.2-4.6; P < .0001, I2 = 0). The hazard ratio for disease-specific survival in current smokers was 6.3 (95% CI, 1.3-29.3; P = .0194, I2 = 0). Ever smoking had a larger impact on overall survival and disease-specific survival than the 10–pack year smoking threshold. Conclusion Smoking negatively affects survival in patients with HPV-related oropharyngeal carcinoma across all outcomes. Current smoking during treatment is associated with the greatest reduction in survival, possibly secondary to diminished radiation therapy efficacy.

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“…Thus, the present analysis validated the findings reported by Sharp et al ( 9 ). This is noteworthy, as the evidence in the literature is not unanimous, with various studies reporting effects of smoking habit on survival outcomes only when: i) Treatment regimens included radiotherapy; ii) the tumors were HPV-negative; and iii) p16 INK4A status in immunohistochemistry was additionally stratified for ( 14 , 19 , 20 ), whereas others did not see an association between smoking habit and survival under any circumstances ( 4 , 5 ). In the present study, neither HPV nor p16 INK4A status were included in the analysis, as all patients were treated prior to the routine inclusion of these parameters into patient check-ups.…”

Section: Discussionmentioning

confidence: 99%

“…HPV accounts for a substantial proportion of SCCs, specifically of the tonsils (oropharynx), with a positive impact on survival (1,2), whereas the components found in tobacco smoke and alcohol are associated with the genesis of laryngeal and hypopharyngeal SCC (3). Although there are some conflicting data (4)(5)(6), it is widely accepted that smoking has a significant negative effect on the survival of patients with HNSCC (1,2). There have been various primarily retrospective studies into the course of disease of smokers in comparison to former smokers and lifelong non-smokers, with additional focus on pre-and post-treatment smoking habit of patients in some of these studies (4)(5)(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Alteration of smoking habit at time of first diagnosis influences survival of patients with HNSCC

et al. 2020

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The impact of smoking on survival in patients with squamous cell carcinoma of the head and neck is well established, despite some conflicting data in the literature. However, data on alterations of smoking habit following cancer diagnosis is sparse. In the present study, the effect of reduction of smoking compared with cessation on the course of disease was studied. Data from 643 patients with HNSCC from the tumor documentation registry of the Department of Otorhinolaryngology, Head and Neck Surgery of the Christian-Albrechts-University Kiel were collected and statistically analyzed, looking at pre- and post-treatment smoking habit and survival. Alteration of smoking at the first diagnosis of HNSCC led to a significantly beneficial effect on survival outcomes compared with continued smoking, without significant differences between reduction and cessation of smoking. Detailed analysis revealed that this effect was solely dependent on patients treated by surgery only. Lifelong non-smokers exhibited a significant survival advantage compared with active and former smokers, with no difference in survival between these last two groups. The positive influence of altered smoking habit following first time diagnosis on disease-specific survival paralleled the negative direct effect of active smoking on therapy, which is predominantly attributed to peritumoral tissue hypoxia leading to impaired efficacy of radiochemotherapy (RCT). In the present study cohort, the positive effect of smoking habit alterations were primarily observed in patients treated by surgery only instead of RCT, possibly due to fewer perioperative complications. These findings indicated that patients should be encouraged to at least minimize smoking following cancer diagnosis. Furthermore, for survival estimates and therapy planning, former smokers should be considered as active smokers.

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Impact of human papillomavirus and smoking on survival outcomes after transoral robotic surgery

Abstract: HPV status may be more important than smoking status in determining the risk of disease recurrence and death in patients treated with TORS.

Cited by 17 publications

References 27 publications

Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Survival and Gastrostomy Prevalence in Patients With Oropharyngeal Cancer Treated With Transoral Robotic Surgery vs Chemoradiotherapy

Impact of Smoking on Survival Outcomes in HPV‐Related Oropharyngeal Carcinoma: A Meta‐analysis

Alteration of smoking habit at time of first diagnosis influences survival of patients with HNSCC

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