Influence of Smoking History on Imaging Characteristics Among Patients With Human Papillomavirus-Positive Oropharyngeal Cancer

Abstract

Background and Purpose Human papillomavirus (HPV)-positive oropharyngeal cancers represent a distinct clinical entity with more favorable prognosis than HPV-negative oropharyngeal cancers. However, among patients with HPV-positive oropharyngeal carcinomas, those with a significant smoking history have a much worse prognosis. Recently, imaging characteristics of oropharyngeal cancers were identified as markers of poor prognosis. The purpose of this study was to determine whether nodal imaging characteristics differ between smokers and never/light smokers with HPV-positive oropharyngeal cancer. Materials and Methods Review of 130 pretreatment CT examinations of HPV-positive oropharyngeal cancers in smokers (>10 pack-years) and never/light smokers (≤10 pack-years) matched for T stage and tumor subsite was performed with the reviewing radiologist blinded to HPV status, smoking history, and clinical stage. An additional 24 pretreatment CT examinations of patients with HPV-negative oropharyngeal cancers were also reviewed in a blinded fashion. Imaging characteristics of metastatic nodal disease were compared using chi-square testing (Fisher exact testing where appropriate) and McNemar chi-square testing for the matched-pair analysis. Results As expected, those with HPV-positive oropharyngeal cancer were more likely to be younger, male, non-Hispanic white, never/former smokers, and never drinkers than those with HPV-negative oropharyngeal cancer. Furthermore, the HPV-positive oropharyngeal cancers were more likely to be in the tonsil, smaller T-category, higher N-category, poorly differentiated, tonsil primaries, smaller T-category, higher N-category, and poorly differentiated than HPV-negative oropharyngeal cancers. However, among the HPV-positive oropharyngeal cancers, we could identify no obvious difference in the pretreatment imaging characteristics of paired smokers and never/light smokers. Conclusions Among patients with HPV-positive oropharyngeal cancer, no imaging characteristics were identified to correlate with the critical prognostic feature smoking status. Cystic and necrotic nodal metastases, as described previously, were more common among patients with HPV-positive than HPV-negative oropharyngeal cancers. While cystic nodal metastases were more common among never/light smokers with HPV-positive oropharyngeal cancer than smokers with HPV-positive oropharyngeal cancer; however, because these results did not reach statistical significance, we conclude that imaging results cannot serve as a surrogate for an HPV-driven phenotype.

Prognostic factors for human papillomavirus–positive and negative oropharyngeal carcinomas

“…This dramatic shift in the epidemiology of OPSCC is attributed both to a decline in tobacco use and an apparent increase in exposure to sexually transmitted oral HPV infection . Compared to HPV‐negative counterparts, HPV‐positive OPSCC patients are more likely to be nonsmokers, white, male, of a higher socioeconomic status, and have a history of multiple sexual partners . HPV‐positive patients also have significantly improved prognosis compared with HPV‐negative patients, with higher response rates to chemoradiation treatment, higher control rates with surgery and adjuvant treatment, and better overall survival both at diagnosis and after disease progression, relative to HPV‐negative OPSCC patients .…”

“…6,10 Compared to HPV-negative counterparts, HPV-positive OPSCC patients are more likely to be nonsmokers, white, male, of a higher socioeconomic status, and have a history of multiple sexual partners. [11][12][13][14] HPVpositive patients also have significantly improved prognosis compared with HPV-negative patients, 13,15 with higher response rates to chemoradiation treatment, 16 higher control rates with surgery and adjuvant treatment, 17 and better overall survival both at diagnosis 13,16,18 and after disease progression, relative to HPV-negative OPSCC patients. [19][20][21] Recent studies have also shown that the extent of nodal disease differs for HPV-positive and HPVnegative OPSCC.…”

Radiomics outperforms clinical factors in characterizing human papilloma virus (HPV) for patients with oropharyngeal squamous cell carcinomas

“…Methods for HPV prediction (in the context of OPSCC) using quantitative image analysis methods, such as radiomics, have been evaluated [18,[47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]. Several previous studies [18, 47, 49-54, 56-65, 67-75] have focused on the use of radiomics signatures for prediction of HPV status, and differentiation between HPV+/-in patients with OPSCC's.…”

Prognostic Significance of Smoking in Human Papillomavirus–Positive Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage

“…Since the 1980s, HNC rates due to HPV have been rising, whereas the incidence of HNC associated with more traditional risk factors, such as tobacco, has decreased . The majority of HPV‐positive HNCs arise from the oropharynx, and these cancers are more common in younger patients and patients with a lower cumulative pack‐years or absent history of smoking . HPV‐positive oropharyngeal squamous cell carcinoma (OPSCC) has a better prognosis than its HPV‐negative counterpart .…”