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- Title
Rethinking the 10-pack-year rule for favorable human papillomavirus-associated oropharynx carcinoma: A multi-institution analysis.
- Authors
Broughman, James R.; Xiong, David D.; Moeller, Benjamin J.; Contrera, Kevin J.; Prendes, Brandon L.; Lamarre, Eric D.; Ku, Jamie A.; Burkey, Brian B.; Woody, Neil M.; Joshi, Nikhil P.; Adelstein, David J.; Geiger, Jessica L.; Frenkel, Catherine H.; Milas, Zvonimir L.; Brickman, Daniel S.; Sumrall, Ashley L.; Carrizosa, Daniel R.; Greskovich, John F.; Koyfman, Shlomo A.; Ward, Matthew C.
- Abstract
<bold>Background: </bold>De-intensified treatment strategies for early human papillomavirus-positive (HPV+) oropharynx cancer (OPC) rely on selecting patients with an excellent prognosis. The criterion for enrollment in current de-intensification trials is ≤10 pack-years. More nuance to the pack-year criteria may expand enrollment, improve patient outcomes, and prevent overtreatment. It was hypothesized that patients with more than 10 pack-years may experience favorable outcomes if smoking cessation has been achieved.<bold>Methods: </bold>From an institutional review board-approved database, patients with HPV+ oropharyngeal squamous carcinoma treated definitively with radiation with or without chemotherapy were retrospectively identified. Patients with a history of smoking who were eligible for national de-intensification trials were included (cT1-2N1-2b or T3N0-2b [American Joint Committee on Cancer, seventh edition]). Cox regression with penalized smoothing splines was used to evaluate nonlinear effects of cessation. Recursive partitioning analysis (RPA) was used to objectively search for relationships between the 2 colinear variables (pack-years and time since cessation).<bold>Results: </bold>Among 330 patients meeting the inclusion criteria, 130 (40%) were never smokers, 139 (42%) were former smokers, and 61 (18%) were current smokers. With standard therapy, all former smokers achieved a progression-free survival (PFS) rate higher than 91%, regardless of pack-year exposure. Nonlinear Cox regression demonstrated that more recent cessation was associated with significantly worse PFS even among those with ≤20 pack-years. RPA demonstrated that only current smokers experienced a 2-year PFS rate lower than 91%; former smokers, regardless of pack-years, experienced a 2-year PFS rate higher than 91%.<bold>Conclusions: </bold>The 10-pack-year rule may not apply to all early HPV+ OPCs, particularly for former smokers. Future randomized de-intensification trials should consider a broader and more nuanced approach until the predictive role of smoking status is established.
- Subjects
EX-smokers; NONLINEAR regression; SMOKING cessation; CARCINOMA; PROGRESSION-free survival; PAPILLOMAVIRUSES; RESEARCH; TIME; RESEARCH methodology; OROPHARYNGEAL cancer; PROGNOSIS; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; PAPILLOMAVIRUS diseases; KAPLAN-Meier estimator; RESEARCH funding; SMOKING; DISEASE complications
- Publication
Cancer (0008543X), 2020, Vol 126, Issue 12, p2784
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.32849