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

Ference, Ryan S.; Liao, David; Gao, Qi; Mehta, Vikas

doi:10.1177/0194599820931803

Cited by 10 publications

(11 citation statements)

References 41 publications

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“…Contrary to the above systematic reviews, 13,14 our data did not reflect a negative impact of smoking on survival in early stage disease which may be due to our single study having insufficient numbers in each group. The impact of smoking on survival may also be more pronounced in advanced stage disease, potentially from reduced efficacy of overall treatment previously described including radiotherapy resistance 14 . Ference et al also concluded that smoking increased disease progression in HPV positive OPC 14 …”

Section: Discussioncontrasting

confidence: 99%

“…Our results demonstrate the negative impact of smoking on survival in stage III HPV positive OPC; however, no difference was noted in early stage disease. Two meta‐analyses, one by Chen et al and the other by Ference et al, showed that smoking adversely impacts recurrence and survival rates in patients with HPV positive OPC regardless of stage 13,14 . Contrary to the above systematic reviews, 13,14 our data did not reflect a negative impact of smoking on survival in early stage disease which may be due to our single study having insufficient numbers in each group.…”

Section: Discussioncontrasting

confidence: 80%

“…Two meta‐analyses, one by Chen et al and the other by Ference et al, showed that smoking adversely impacts recurrence and survival rates in patients with HPV positive OPC regardless of stage 13,14 . Contrary to the above systematic reviews, 13,14 our data did not reflect a negative impact of smoking on survival in early stage disease which may be due to our single study having insufficient numbers in each group. The impact of smoking on survival may also be more pronounced in advanced stage disease, potentially from reduced efficacy of overall treatment previously described including radiotherapy resistance 14 .…”

Section: Discussioncontrasting

confidence: 80%

“…The impact of smoking on survival may also be more pronounced in advanced stage disease, potentially from reduced efficacy of overall treatment previously described including radiotherapy resistance 14 . Ference et al also concluded that smoking increased disease progression in HPV positive OPC 14 …”

Section: Discussionmentioning

confidence: 95%

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Impact of smoking on stage‐specific survival in human papilloma virus–associated oropharyngeal squamous cell carcinoma

et al. 2021

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Background The American Joint Committee on Cancer (AJCC) released a new staging system for human papilloma virus (HPV) positive oropharyngeal cancer (OPC) in their eighth edition. The role of smoking in HPV positive oropharyngeal cancer remains controversial and is not factored into the updated staging system. Methods Single institutional, retrospective chart review of patients with HPV positive OPC from 2009 to 2017 was completed. Dichotomized smoking data were collected into 0–9 and ≥10 pack‐year histories. Kaplan–Meier survival curves compared overall survival (OS) for smokers and nonsmokers. Results Five‐year OS was not statistically different in stage I or stage II HPV positive OPC comparing nonsmokers versus smokers, but worse in stage III smokers (38% vs. 76%, p < 0.05). Conclusion Greater than 10 pack‐year smoking status may negatively affect survival in late stage HPV positive OPC but not in early stage disease. HPV positive smokers may require additional risk stratification.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussioncontrasting

confidence: 80%

Section: Discussioncontrasting

confidence: 80%

Section: Discussionmentioning

confidence: 95%

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Impact of smoking on stage‐specific survival in human papilloma virus–associated oropharyngeal squamous cell carcinoma

et al. 2021

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“…Another study identified Helicobacter pylori co-infection is common in OPSCC, perhaps more so than HPV [122]. We suspect that tobacco use may facilitate a similar environment, explaining why cigarette smoking is a negative prognostic factor, even in HPV positive cancers [123,124]. In order to understand how microbiome compositional shifts can affect the mucosal homeostasis, a few groups have reported in silico gene expression analysis of the oral microbiome and how it relates to HPV positive OPSCC [125][126][127].…”

Section: The Microbiome As a Primer For Inflammation And Hpv Mediated...mentioning

confidence: 99%

It Takes Two to Tango: A Review of Oncogenic Virus and Host Microbiome Associated Inflammation in Head and Neck Cancer

McKeon

Gallant

Kim

et al. 2022

Cancers

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While the two primary risk factors for head and neck squamous cell carcinoma (HNSCC) are alcohol and tobacco, viruses account for an important and significant upward trend in HNSCC incidence. Human papillomavirus (HPV) is the causative agent for a subset of oropharyngeal squamous cell carcinoma (OPSCC)—a cancer that is impacting a rapidly growing group of typically middle-aged non-smoking white males. While HPV is a ubiquitously present (with about 1% of the population having high-risk oral HPV infection at any one time), less than 1% of those infected with high-risk strains develop OPSCC—suggesting that additional cofactors or coinfections may be required. Epstein–Barr virus (EBV) is a similarly ubiquitous virus that is strongly linked to nasopharyngeal carcinoma (NPC). Both of these viruses cause cellular transformation and chronic inflammation. While dysbiosis of the human microbiome has been associated with similar chronic inflammation and the pathogenesis of mucosal diseases (including OPSCC and NPC), a significant knowledge gap remains in understanding the role of bacterial-viral interactions in the initiation, development, and progression of head and neck cancers. In this review, we utilize the known associations of HPV with OPSCC and EBV with NPC to investigate these interactions. We thoroughly review the literature and highlight how perturbations of the pharyngeal microbiome may impact host-microbiome-tumor-viral interactions—leading to tumor growth.

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Preoperative Circulating Tumor HPV DNA and Oropharyngeal Squamous Cell Disease

Lam,

Sangal,

Aggarwal

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceThe utility of preoperative circulating tumor tissue-modified viral human papillomavirus DNA (TTMV-HPV DNA) levels in predicting human papillomavirus (HPV)–associated oropharyngeal squamous cell carcinoma (HPV+ OPSCC) disease burden is unknown.ObjectiveTo determine if preoperative circulating tumor HPV DNA (ctHPVDNA) is associated with disease burden in patients with HPV+ OPSCC who have undergone transoral robotic surgery (TORS).Design, Setting, and ParticipantsThis cross-sectional study comprised patients with HPV+ OPSCC who underwent primary TORS between September 2021 and April 2023 at one tertiary academic institution. Patients with treatment-naive HPV+ OPSCC (p16-positive) and preoperative ctHPVDNA levels were included, and those who underwent neck mass excision before ctHPVDNA collection were excluded.Main Outcomes and MeasuresThe main outcome was the association of increasing preoperative ctHPVDNA levels with tumor size and lymph node involvement in surgical pathology. The secondary outcome was the association between preoperative ctHPVDNA levels and adverse pathology, which included lymphovascular invasion, perineural invasion, or extranodal extension.ResultsA total of 70 patients were included in the study (65 men [93%]; mean [SD] age, 61 [8] years). Baseline ctHPVDNA levels ranged from 0 fragments/milliliter of plasma (frag/mL) to 49 452 frag/mL (median [IQR], 272 [30-811] frag/mL). Overall, 58 patients (83%) had positive results for ctHPVDNA, 1 (1.4%) had indeterminate results, and 11 (15.6%) had negative results. The sensitivity of detectable ctHPVDNA for identifying patients with pathology-confirmed HPV+ OPSCC was 84%. Twenty-seven patients (39%) had pathologic tumor (pT) staging of pT0 or pT1, 34 (49%) had pT2 staging, and 9 patients (13%) had pT3 or pT4 staging. No clinically meaningful difference between detectable and undetectable preoperative ctHPVDNA cohorts was found for tumor size or adverse pathology. Although the median preoperative ctHPVDNA appeared to be higher in pT2 through pT4 stages and pN1 or pN2 stages, effect sizes were small (pT stage: η2, 0.002 [95% CI, −1.188 to 0.827]; pN stage: η2, 0.043 [95% CI, −0.188 to 2.600]). Median preoperative log(TTMV-HPV DNA) was higher in active smokers (8.79 [95% CI, 3.55-5.76]), compared with never smokers (5.92 [95% CI, −0.97 to 1.81]) and former smokers (4.99 [95% CI, 0.92-6.23]). Regression analysis did not show an association between tumor dimension or metastatic lymph node deposit size and preoperative log(TTMV-HPV DNA). After univariate analysis, no association was found between higher log(TTMV-HPV DNA) levels and adverse pathology.Conclusions and RelevanceIn this cross-sectional study, preoperative ctHPVDNA levels were not associated with disease burden in patients with HPV+ OPSCC who underwent TORS.

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

Cited by 10 publications

References 41 publications

Impact of smoking on stage‐specific survival in human papilloma virus–associated oropharyngeal squamous cell carcinoma

Impact of smoking on stage‐specific survival in human papilloma virus–associated oropharyngeal squamous cell carcinoma

It Takes Two to Tango: A Review of Oncogenic Virus and Host Microbiome Associated Inflammation in Head and Neck Cancer

Preoperative Circulating Tumor HPV DNA and Oropharyngeal Squamous Cell Disease

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