title: Influence of smoking history on imaging characteristics among patients with human papillomavirus-positive oropharyngeal cancer: a blinded matched-pair analysis.
abstract: OBJECTIVE
  Human papillomavirus (HPV)-positive oropharyngeal cancers represent a distinct clinical entity with more favorable prognosis than do 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.
  
  
  METHODS
  A review of 130 pretreatment computed tomographic 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 the HPV status, smoking history, and clinical stage. Additionally 24 pretreatment computed tomographic examinations of patients with HPV-negative oropharyngeal cancers were also reviewed in a blinded fashion. Imaging characteristics of metastatic nodal disease were compared using the testing (Fisher exact testing where appropriate) and McNemar 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 were 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, than were the 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 the 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 the patients with HPV-positive than those with HPV-negative oropharyngeal cancers. Although cystic nodal metastases were more common among the never/light smokers with HPV-positive oropharyngeal cancer than among smokers with HPV-positive oropharyngeal cancer, however, because these results did not reach statistical significance, we concluded that the imaging results cannot serve as a surrogate for an HPV-driven phenotype.
authors.affiliation: From the *Department of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, †Department of Radiology, The University of Texas Health Science Center, ‡The University of Texas Medical School at Houston, Departments of §Head and Neck Surgery, ∥Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX; and ¶Duke Cancer Institute, Duke University Medical Center, Durham, NC.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Cantrell
authors.forename: Holly H
authors.initials: HH
authors.lastname: Reid
authors.forename: Guojun
authors.initials: G
authors.lastname: Li
authors.forename: Qingyi
authors.initials: Q
authors.lastname: Wei
authors.forename: Erich M
authors.initials: EM
authors.lastname: Sturgis
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Ginsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000401:mortality*; D015984:Causality; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*; D030361:Papillomavirus Infections / Q000000981:diagnostic imaging* / Q000401:mortality*; D011230:Precancerous Conditions / Q000000981:diagnostic imaging / Q000401:mortality*; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality*; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D055815:Young Adult