Tobacco use in human papillomavirus-positive advanced oropharynx cancer patients related to increased risk of distant metastases and tumor recurrence.
OBJECTIVE
The goal of this study was to examine the effect of tobacco use on disease recurrence (local/regional recurrence, distant metastasis, or second primary) among patients with human papillomavirus (HPV)-positive squamous cell carcinoma of the oropharynx (SCCOP) following a complete response to chemoradiation therapy.


METHODS
Between 1999 and 2007, 124 patients with advanced SCCOP (86% with stage IV) and adequate tumor tissue for HPV analysis who were enrolled in one of two consecutive University of Michigan treatment protocols were prospectively included in this study. Patients were categorized as never-, former, or current tobacco users. The primary end points were risk of disease recurrence and time to recurrence; secondary end points were disease-specific survival and overall survival.


RESULTS
One hundred and two patients (82.3%) had HPV-positive tumors. Over two thirds (68%) of patients with HPV-positive tumors were tobacco users. Among HPV-positive patients, current tobacco users were at significantly higher risk of disease recurrence than never-tobacco users (hazard ratio, 5.2; confidence interval, 1.1-24.4; P = 0.038). Thirty-five percent of HPV-positive ever tobacco users recurred compared with only 6% of HPV-positive never users and 50% of HPV-negative patients. All HPV-negative patients were tobacco users and had significantly shorter times to recurrence (P = 0.002), and had reduced disease-specific survival (P = 0.004) and overall survival (P < 0.001) compared with HPV-positive patients. Compared with HPV-positive never-tobacco users, those with a tobacco history showed a trend for reduced disease-specific survival (P = 0.064) but not overall survival (P = 0.221).


CONCLUSIONS
Current tobacco users with advanced, HPV-positive SCCOP are at higher risk of disease recurrence compared with never-tobacco users.
Departments of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Jessica H
JH
Maxwell
Bhavna
B
Kumar
Felix Y
FY
Feng
Francis P
FP
Worden
Julia S
JS
Lee
Avraham
A
Eisbruch
Gregory T
GT
Wolf
Mark E
ME
Prince
Jeffrey S
JS
Moyer
Theodoros N
TN
Teknos
Douglas B
DB
Chepeha
Jonathan B
JB
McHugh
Susan G
SG
Urba
Jay
J
Stoerker
Heather M
HM
Walline
David M
DM
Kurnit
Kitrina G
KG
Cordell
Samantha J
SJ
Davis
Preston D
PD
Ward
Carol R
CR
Bradford
Thomas E
TE
Carey
D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009959:Oropharyngeal Neoplasms / Q000150:complications* / Q000473:pathology / Q000821:virology*; D027383:Papillomaviridae / Q000302:isolation & purification*; D012306:Risk; D012907:Smoking / Q000009:adverse effects*