ONCOmmunity

Impact of Smoking on Treatment Outcomes in Patients With Human Papillomavirus-Related Oropharyngeal Cancer.

By: Michelle M Kwan, Latifa A Bazzi, Zequn Sun, Dayton Rand, Asher Park, Shravan Asthana, Alexis Larson, Poonam Yadav, Bharat B Mittal, Adil Akthar, Sarah Kramer, Jochen H Lorch, Sandeep Samant, Urjeet Patel, Michelle L Mierzwa, Leila J Mady, Katelyn O Stepan, Laila A Gharzai

Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
2026-4-9; doi: 10.1002/hed.70298

Abstract

Background

Patients with HPV+ oropharyngeal cancer (OPC) have worse outcomes with longer smoking history (≥ 10 pack-years). This has been confirmed in trials of primary radiotherapy but not surgery, suggesting differential smoking impact by treatment received. We assessed smoking-related outcomes at a single institution.

Methods

Kaplan-Meier and Cox proportional hazards regression compared < 10 versus ≥ 10 pack-years by treatment received for progression-free survival (PFS) and overall survival (OS).

Results

Smoking was associated with worse PFS in both primary (chemo)radiation (HR = 1.73 [1.12-2.69], p = 0.01) and primary surgery cohorts (HR = 1.77 [1.02-3.07], p = 0.04). In surgery patients, this association was attenuated after adjusting for socioeconomic indicators (HR = 1.69 [0.97-2.93], p = 0.06). On recursive partitioning analysis, ≥ 25 pack-years was associated with worse PFS and OS overall and among radiotherapy patients.

Conclusions

Smoking impacts outcomes in HPV + OPC regardless of treatment modality. Treatment-specific differences in prior randomized studies may reflect underlying differences in patient characteristics. ≥ 25 pack-years was associated with worse outcomes.