Low risk of second primary malignancies among never smokers with human papillomavirus-associated index oropharyngeal cancers.
BACKGROUND
Among patients with index oropharyngeal cancer, second primary malignancies (SPMs) may be less common in cases of human papillomavirus (HPV)-associated tumors than HPV-negative tumors. Further modification of these SPM risks by smoking has not been reported.


METHODS
SPM outcomes of 356 patients with incident oropharyngeal cancer were analyzed using Cox proportional hazards and Kaplan-Meier models. SPM risk and SPM-free survival were compared in HPV-seronegative patients, HPV-seropositive never smokers, and HPV-seropositive ever smokers.


RESULTS
HPV-seropositive patients had a lower 5-year SPM rate than HPV-seronegative patients (5.6% vs 14.6%; p = .051). Compared to HPV-seronegative patients, HPV-seropositive never smokers had a 73% reduced SPM risk, and HPV-seropositive ever smokers had a 27% reduced SPM risk (trend p = .028). Although HPV-seronegative patients had SPMs in traditional locations, 70% of SPMs among HPV-seropositive patients were outside typical tobacco-related sites.


CONCLUSIONS
HPV serologic status and smoking may stratify patients with index oropharyngeal cancers in terms of risk and location of SPMs.
Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Brandon W
BW
Peck
Kristina R
KR
Dahlstrom
Samuel J
SJ
Gan
Wes
W
Caywood
Guojun
G
Li
Qingyi
Q
Wei
Mark E
ME
Zafereo
Erich M
EM
Sturgis
D000914:Antibodies, Viral / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000821:virology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000453:epidemiology*; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000821:virology*; D027383:Papillomaviridae / Q000276:immunology; D030361:Papillomavirus Infections / Q000821:virology*; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects*
D000914:Antibodies, Viral