Department of Otolaryngology-Head and Neck Surgery, Rutgers University, Newark, New Jersey.
Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
Cancer. 2020 Jan 1;126(9):1873-1887. doi: 10.1002/cncr.32739. Epub 2020 Feb 7.
When treated nonsurgically with definitive chemoradiation, smokers with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) have a worse prognosis compared with their nonsmoking counterparts. To the authors' knowledge, the prognostic significance of smoking in surgically treated patients is unknown.
The current study is a retrospective case series of patients with HPV-positive OPSCC who underwent upfront transoral robotic surgery at a single institution from 2010 through 2017. Exclusion criteria were nonoropharyngeal primary tumors, histology other than SCC, HPV-negative tumors, previous history of head and neck cancer, and/or previous head and neck radiotherapy. Recurrence-free survival (RFS), overall survival, and disease-specific survival were compared using the Kaplan-Meier method and the log-rank test. Smoking history was categorized as never smokers (<1 pack-year), current smokers (smoking at the time of the cancer diagnosis), and former smokers.
A total of 258 patients met the study criteria. The average age was 60 years, and approximately 87% of patients were male. A total of 148 patients (57.4%) were smokers whereas 110 (42.6%) reported never smoking. There were 44 active smokers (17.1%) and 104 former smokers (40.3%). The median follow-up was 3.23 years. There were 17 patients of disease recurrence. Smoking pack-year history was not found to be significant for RFS (hazard ratio, 1.01; 95% CI, 0.99-1.03 [P = .45]). There was no significant difference in RFS noted between never and ever smokers (92% vs 89.8%; P = .85) nor was there a difference observed between never, former, and current smokers (92% vs 91.5% vs 86.1%, respectively; P = .69).
A smoking history is common in patients with HPV-positive OPSCC. In the current study, HPV-positive smokers were found to have excellent survival and locoregional control, similar to their nonsmoking counterparts. The results of the current study do not support the exclusion of smokers with early-stage, HPV-positive OPSCC from transoral robotic surgery-based deintensification trials.
在接受确定性放化疗的非手术治疗时，人乳头瘤病毒（HPV）阳性口咽鳞状细胞癌（OPSCC）的吸烟者与非吸烟者相比预后更差。据作者所知，吸烟在接受手术治疗的患者中的预后意义尚不清楚。
本研究是对 2010 年至 2017 年在一家机构接受经口机器人手术的 HPV 阳性 OPSCC 患者的回顾性病例系列研究。排除标准为非口咽原发性肿瘤、非 SCC 组织学、HPV 阴性肿瘤、头颈部癌症病史和/或头颈部放疗史。采用 Kaplan-Meier 法和对数秩检验比较无复发生存率（RFS）、总生存率和疾病特异性生存率。吸烟史分为从不吸烟者（<1 包/年）、当前吸烟者（癌症诊断时吸烟）和以前吸烟者。
共有 258 例患者符合研究标准。平均年龄为 60 岁，约 87%的患者为男性。共有 148 例（57.4%）为吸烟者，110 例（42.6%）为从不吸烟者。有 44 例现吸烟者（17.1%）和 104 例前吸烟者（40.3%）。中位随访时间为 3.23 年。有 17 例患者发生疾病复发。吸烟包年史与 RFS 无显著相关性（风险比，1.01；95%置信区间，0.99-1.03[P=0.45]）。从不吸烟者与吸烟者之间 RFS 无显著差异（92% vs 89.8%；P=0.85），从不吸烟者、前吸烟者和现吸烟者之间也无差异（92% vs 91.5% vs 86.1%，分别；P=0.69）。
HPV 阳性 OPSCC 患者中吸烟史很常见。在本研究中，HPV 阳性吸烟者的生存和局部区域控制良好，与非吸烟者相似。本研究结果不支持将早期 HPV 阳性 OPSCC 吸烟者排除在基于经口机器人手术的减量化试验之外。
