Objectives
The effect of smoking and human papilloma virus (HPV) on overall survival (OS) of oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing concurrent chemoradiation (CCRT) remains unclear.
Study Design
Retrospective Review
Methods
Clinical characteristics of OPSCC patients treated between 2008– 2015 with CCRT were abstracted from medical records. OS curves and multivariate cox proportional hazard ratios (HR) were examined.
Results
Out of 120 evaluable patients, 71% had HPV+ tumors. Median follow-up duration for the entire cohort was 41.5 months (6–88 months). HPV+ current smokers experienced significantly worse 5 year OS (73% alive vs. 36% alive, p=0.01) with a similar trend in HPV− current smokers (66% alive vs. 31% alive, p=0.28) compared to former/never smokers undergoing CCRT. In a multivariate cox proportional hazard model adjusted for age, gender, and overall tumor stage, HPV+ current smokers experienced nearly a four-fold increase in overall mortality in comparison to HPV+ never/former smokers (HR= 3.68, 95% CI=1.35–10.0). Similarly, current smokers with HPV− tumors (HR= 6.8, 95% CI=1.11–41.67) had increased mortality compared to never/former smokers.
Conclusions
Current smoking is associated with poor prognosis, independent of HPV status, in OPSCC CCRT treated patients. Current smoking produced an approximately 4 to 7 fold increase in risk of mortality for HPV+ and HPV− patients respectively. Regardless of pack-years, efforts should be made to achieve smoking cessation before CCRT regardless of HPV status.