title: Smoking cessation is associated with improved survival in oropharynx cancer treated by chemoradiation.
abstract: The effect of smoking and human papillomavirus (HPV) on overall survival (OS) of oropharyngeal squamous cell carcinoma (OPSCC) patients undergoing concurrent chemotherapy (CCRT) remains unclear.
  
  
  
  Retrospective review.
  
  
  
  Clinical characteristics of OPSCC patients treated between 2008 and 2015 with CCRT were abstracted from medical records. OS curves and multivariate cox proportional hazard ratios (HRs) were examined.
  
  
  
  Of 120 evaluable patients, 71% had HPV+tumors. Median follow-up duration for the entire cohort was 41.5 months (range = 6-88 months). HPV+current smokers experienced significantly worse 5-year OS (73% alive vs. 36% alive, P = .01) and there was a similar trend in HPV-current smokers (66% alive vs. 31% alive, P = .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 fourfold 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 = 6.80, 95% CI = 1.11-41.67) had increased mortality compared to never/former smokers.
  
  
  
  Current smoking is associated with poor prognosis, independent of HPV status, in CCRT-treated OPSCC patients. Current smoking produced an approximately four- to sevenfold increase in risk of mortality for HPV+and HPV-patients, respectively. Regardless of pack years and HPV status, efforts should be made to achieve smoking cessation before CCRT.
  
  
  
  4. Laryngoscope, 126:2733-2738, 2016.
authors.affiliation: Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Alexis J
authors.initials: AJ
authors.lastname: Platek
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Vijayvel
authors.initials: V
authors.lastname: Jayaprakash
authors.affiliation: Pathology, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Mihai
authors.initials: M
authors.lastname: Merzianu
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Platek
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: David M
authors.initials: DM
authors.lastname: Cohan
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Wesley L
authors.initials: WL
authors.lastname: Hicks
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Sathiya P
authors.initials: SP
authors.lastname: Marimuthu
authors.affiliation: Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Winslow
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Vishal
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Hassan
authors.initials: H
authors.lastname: Arshad
authors.affiliation: Head and Neck/Plastic and Reconstructive Surgery, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Moni A
authors.initials: MA
authors.lastname: Kuriakose
authors.affiliation: Biostatistics, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Shiva
authors.initials: S
authors.lastname: Dibaj
authors.affiliation: Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: James R
authors.initials: JR
authors.lastname: Marshall
authors.affiliation: Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Reid
authors.affiliation: Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, U.S.A.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Warren
authors.affiliation: Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, New York, U.S.A.
authors.forename: Anurag K
authors.initials: AK
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000628:therapy* / Q000821:virology; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016540:Smoking Cessation
keywords: Tobacco; base of tongue; human papillomavirus; nicotine; squamous cell cancer of the head and neck