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Effects of Smoking and Drinking on Oropharyngeal Cancer Outcome by HPV Serostatus: A Prospective Cohort Study

Cao, Simon (2021) Effects of Smoking and Drinking on Oropharyngeal Cancer Outcome by HPV Serostatus: A Prospective Cohort Study. Master Essay, University of Pittsburgh.

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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.

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).

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].

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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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Cao, Simonsic40@pitt.edusic40
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairGlynn, Nancy W.epidnwg@pitt.eduepidnwgUNSPECIFIED
Committee MemberDiergaarde, Brendabbd3@pitt.edubbd3UNSPECIFIED
Committee MemberStabile, Laura P.stabilela@upmc.eduUNSPECIFIEDUNSPECIFIED
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: Graduate 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 2021 13:14


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