Cao, Simon
(2021)
Effects of Smoking and Drinking on Oropharyngeal Cancer Outcome by HPV Serostatus: A Prospective Cohort Study.
Master Essay, University of Pittsburgh.
Abstract
Background
The incidence of human papillomavirus (HPV)-driven oropharyngeal cancer (OPC) continues to increase in the US. Patients with HPV-positive [HPV(+)] OPC often have better outcomes than those with HPV-negative [HPV(-)] OPC. To reduce treatment-related morbidity from HPV(+) OPC, “de-escalation” strategies are being evaluated. We investigated the relationship between smoking and alcohol history at diagnosis and OPC prognosis to explore whether this easy-to-obtain information can aid selection of patients that can be successfully treated with less intensive therapies.
Methods
The study population consisted of 371 patients diagnosed with OPC at UPMC otolaryngology clinics [243 HPV(+), 128 HPV(-)]. Information on smoking and alcohol use were collected via interviewer-administered questionnaires; clinical and outcome information was abstracted from medical records. HPV positivity was defined as seropositivity for antibodies against sets of HPV16 or HPV18 antigens. The Kaplan-Meier method and Cox proportional hazards models were used to assess the effects of smoking and alcohol use on overall survival (OS).
Results
Compared to HPV(-) patients, HPV(+) patients were significantly younger (p=0.005), more often male (p<0.0001), more often never smokers (p=0.0008), and smoked fewer pack-years (p<0.0001); no significant difference was observed in number of drinks-per-day or drinking status. Grouping by a smoking cutoff of 2 pack-years and controlling for age, sex, race, and stage, those with low smoking exposure had better OS than those with high exposure for both HPV-stratified groups [HPV(+) p=0.015, HPV(-) p=0.0026]. In contrast, the clinically-used 10 pack-years cutoff was not associated with OS in HPV(+) individuals after adjustment [HPV(+) p=0.11, HPV(-) p=0.0083]. When an alcoholic drinks-per-day measure and 2 pack-years smoking cutoff were included in a single model adjusting for age, sex, race, and stage, drinks-per-day was not significantly associated with OS [HPV(+) p=0.078, HPV(-) p=0.15]. However, the 2 pack-years smoking cutoff remained significantly associated with OS [HPV(+) p=0.026, HPV(-) p=0.0076].
Conclusion
These results suggest that pack-years smoked is associated with OS in HPV(+) and HPV(-) head and neck cancer patients while drinking intensity is not. A 2 pack-years cutoff value may be more appropriate for public health and clinical applications to represent pack-years smoked compared to the commonly used 10 pack-years cutoff.
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Details
| Item Type: |
Other Thesis, Dissertation, or Long Paper
(Master Essay)
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Committee Chair | Glynn, Nancy W. | epidnwg@pitt.edu | epidnwg | UNSPECIFIED | | Committee Member | Diergaarde, Brenda | bbd3@pitt.edu | bbd3 | UNSPECIFIED | | Committee Member | Stabile, Laura P. | stabilela@upmc.edu | UNSPECIFIED | UNSPECIFIED |
|
| Centers: |
Other Centers, Institutes, Offices, or Units > Hillman Cancer Center |
| Date: |
16 June 2021 |
| Date Type: |
Completion |
| Number of Pages: |
56 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master Essay |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
head and neck, oropharyngeal, cancer, epidemiology, smoking, drinking, pack-years, drinking intensity, HPV, human papillomavirus, survival, outcome, cohort study |
| Date Deposited: |
29 Jun 2021 13:14 |
| Last Modified: |
29 Jun 2023 05:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/41326 |
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