Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer

Maura L. Gillison, Qiang Zhang, Richard Jordan, Weihong Xiao, William H. Westra, Andy Trotti, Sharon Spencer, Jonathan Harris, Christine H. Chung, K. Kian Ang

Research output: Contribution to journalArticle

Abstract

Purpose: Tobacco smoking is associated with oropharynx cancer survival, but to what extent cancer progression or death increases with increasing tobacco exposure is unknown. Patients and Methods: Patients with oropharynx cancer enrolled onto a phase III trial of radiotherapy from 1991 to 1997 (Radiation Therapy Oncology Group [RTOG] 9003) or of chemoradiotherapy from 2002 to 2005 (RTOG 0129) were evaluated for tumor human papillomavirus status by a surrogate, p16 immunohistochemistry, and for tobacco exposure by a standardized questionnaire. Associations between tobacco exposure and overall survival (OS) and progression-free survival (PFS) were estimated by Cox proportional hazards models. Results: Prevalence of p16-positive cancer was 39.5% among patients in RTOG 9003 and 68.0% in RTOG 0129. Median pack-years of tobacco smoking were lower among p16-positive than p16-negative patients in both trials (RTOG 9003: 29 v 45.9 pack-years; P = .02; RTOG 0129: 10 v 40 pack-years; P <.001). After adjustment for p16 and other factors, risk of progression (PFS) or death (OS) increased by 1% per pack-year (for both, hazard ratio [HR], 1.01; 95% CI, 1.00 to 1.01; P = .002) or 2% per year of smoking (for both, HR, 1.02; 95% CI, 1.01 to 1.03; P <.001) in both trials. In RTOG 9003, risk of death doubled (HR, 2.19; 95% CI, 1.46 to 3.28) among those who smoked during radiotherapy after accounting for pack-years and other factors, and risk of second primary tumors increased by 1.5% per pack-year (HR, 1.015; 95% CI, 1.005 to 1.026). Conclusion: Risk of oropharyngeal cancer progression and death increases directly as a function of tobacco exposure at diagnosis and during therapy and is independent of tumor p16 status and treatment.

Original languageEnglish (US)
Pages (from-to)2102-2111
Number of pages10
JournalJournal of Clinical Oncology
Volume30
Issue number17
DOIs
StatePublished - Jun 10 2012

Fingerprint

Oropharyngeal Neoplasms
Radiation Oncology
Radiotherapy
Smoking
Tobacco
Neoplasms
Disease-Free Survival
Survival
Chemoradiotherapy
Proportional Hazards Models
Immunohistochemistry

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer. / Gillison, Maura L.; Zhang, Qiang; Jordan, Richard; Xiao, Weihong; Westra, William H.; Trotti, Andy; Spencer, Sharon; Harris, Jonathan; Chung, Christine H.; Ang, K. Kian.

In: Journal of Clinical Oncology, Vol. 30, No. 17, 10.06.2012, p. 2102-2111.

Research output: Contribution to journalArticle

Gillison, ML, Zhang, Q, Jordan, R, Xiao, W, Westra, WH, Trotti, A, Spencer, S, Harris, J, Chung, CH & Ang, KK 2012, 'Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer', Journal of Clinical Oncology, vol. 30, no. 17, pp. 2102-2111. https://doi.org/10.1200/JCO.2011.38.4099
Gillison, Maura L. ; Zhang, Qiang ; Jordan, Richard ; Xiao, Weihong ; Westra, William H. ; Trotti, Andy ; Spencer, Sharon ; Harris, Jonathan ; Chung, Christine H. ; Ang, K. Kian. / Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer. In: Journal of Clinical Oncology. 2012 ; Vol. 30, No. 17. pp. 2102-2111.
@article{26ef61c7b9884f7eabff17b048c5ad26,
title = "Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer",
abstract = "Purpose: Tobacco smoking is associated with oropharynx cancer survival, but to what extent cancer progression or death increases with increasing tobacco exposure is unknown. Patients and Methods: Patients with oropharynx cancer enrolled onto a phase III trial of radiotherapy from 1991 to 1997 (Radiation Therapy Oncology Group [RTOG] 9003) or of chemoradiotherapy from 2002 to 2005 (RTOG 0129) were evaluated for tumor human papillomavirus status by a surrogate, p16 immunohistochemistry, and for tobacco exposure by a standardized questionnaire. Associations between tobacco exposure and overall survival (OS) and progression-free survival (PFS) were estimated by Cox proportional hazards models. Results: Prevalence of p16-positive cancer was 39.5{\%} among patients in RTOG 9003 and 68.0{\%} in RTOG 0129. Median pack-years of tobacco smoking were lower among p16-positive than p16-negative patients in both trials (RTOG 9003: 29 v 45.9 pack-years; P = .02; RTOG 0129: 10 v 40 pack-years; P <.001). After adjustment for p16 and other factors, risk of progression (PFS) or death (OS) increased by 1{\%} per pack-year (for both, hazard ratio [HR], 1.01; 95{\%} CI, 1.00 to 1.01; P = .002) or 2{\%} per year of smoking (for both, HR, 1.02; 95{\%} CI, 1.01 to 1.03; P <.001) in both trials. In RTOG 9003, risk of death doubled (HR, 2.19; 95{\%} CI, 1.46 to 3.28) among those who smoked during radiotherapy after accounting for pack-years and other factors, and risk of second primary tumors increased by 1.5{\%} per pack-year (HR, 1.015; 95{\%} CI, 1.005 to 1.026). Conclusion: Risk of oropharyngeal cancer progression and death increases directly as a function of tobacco exposure at diagnosis and during therapy and is independent of tumor p16 status and treatment.",
author = "Gillison, {Maura L.} and Qiang Zhang and Richard Jordan and Weihong Xiao and Westra, {William H.} and Andy Trotti and Sharon Spencer and Jonathan Harris and Chung, {Christine H.} and Ang, {K. Kian}",
year = "2012",
month = "6",
day = "10",
doi = "10.1200/JCO.2011.38.4099",
language = "English (US)",
volume = "30",
pages = "2102--2111",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "17",

}

TY - JOUR

T1 - Tobacco smoking and increased risk of death and progression for patients with p16-positive and p16-negative oropharyngeal cancer

AU - Gillison, Maura L.

AU - Zhang, Qiang

AU - Jordan, Richard

AU - Xiao, Weihong

AU - Westra, William H.

AU - Trotti, Andy

AU - Spencer, Sharon

AU - Harris, Jonathan

AU - Chung, Christine H.

AU - Ang, K. Kian

PY - 2012/6/10

Y1 - 2012/6/10

N2 - Purpose: Tobacco smoking is associated with oropharynx cancer survival, but to what extent cancer progression or death increases with increasing tobacco exposure is unknown. Patients and Methods: Patients with oropharynx cancer enrolled onto a phase III trial of radiotherapy from 1991 to 1997 (Radiation Therapy Oncology Group [RTOG] 9003) or of chemoradiotherapy from 2002 to 2005 (RTOG 0129) were evaluated for tumor human papillomavirus status by a surrogate, p16 immunohistochemistry, and for tobacco exposure by a standardized questionnaire. Associations between tobacco exposure and overall survival (OS) and progression-free survival (PFS) were estimated by Cox proportional hazards models. Results: Prevalence of p16-positive cancer was 39.5% among patients in RTOG 9003 and 68.0% in RTOG 0129. Median pack-years of tobacco smoking were lower among p16-positive than p16-negative patients in both trials (RTOG 9003: 29 v 45.9 pack-years; P = .02; RTOG 0129: 10 v 40 pack-years; P <.001). After adjustment for p16 and other factors, risk of progression (PFS) or death (OS) increased by 1% per pack-year (for both, hazard ratio [HR], 1.01; 95% CI, 1.00 to 1.01; P = .002) or 2% per year of smoking (for both, HR, 1.02; 95% CI, 1.01 to 1.03; P <.001) in both trials. In RTOG 9003, risk of death doubled (HR, 2.19; 95% CI, 1.46 to 3.28) among those who smoked during radiotherapy after accounting for pack-years and other factors, and risk of second primary tumors increased by 1.5% per pack-year (HR, 1.015; 95% CI, 1.005 to 1.026). Conclusion: Risk of oropharyngeal cancer progression and death increases directly as a function of tobacco exposure at diagnosis and during therapy and is independent of tumor p16 status and treatment.

AB - Purpose: Tobacco smoking is associated with oropharynx cancer survival, but to what extent cancer progression or death increases with increasing tobacco exposure is unknown. Patients and Methods: Patients with oropharynx cancer enrolled onto a phase III trial of radiotherapy from 1991 to 1997 (Radiation Therapy Oncology Group [RTOG] 9003) or of chemoradiotherapy from 2002 to 2005 (RTOG 0129) were evaluated for tumor human papillomavirus status by a surrogate, p16 immunohistochemistry, and for tobacco exposure by a standardized questionnaire. Associations between tobacco exposure and overall survival (OS) and progression-free survival (PFS) were estimated by Cox proportional hazards models. Results: Prevalence of p16-positive cancer was 39.5% among patients in RTOG 9003 and 68.0% in RTOG 0129. Median pack-years of tobacco smoking were lower among p16-positive than p16-negative patients in both trials (RTOG 9003: 29 v 45.9 pack-years; P = .02; RTOG 0129: 10 v 40 pack-years; P <.001). After adjustment for p16 and other factors, risk of progression (PFS) or death (OS) increased by 1% per pack-year (for both, hazard ratio [HR], 1.01; 95% CI, 1.00 to 1.01; P = .002) or 2% per year of smoking (for both, HR, 1.02; 95% CI, 1.01 to 1.03; P <.001) in both trials. In RTOG 9003, risk of death doubled (HR, 2.19; 95% CI, 1.46 to 3.28) among those who smoked during radiotherapy after accounting for pack-years and other factors, and risk of second primary tumors increased by 1.5% per pack-year (HR, 1.015; 95% CI, 1.005 to 1.026). Conclusion: Risk of oropharyngeal cancer progression and death increases directly as a function of tobacco exposure at diagnosis and during therapy and is independent of tumor p16 status and treatment.

UR - http://www.scopus.com/inward/record.url?scp=84863975396&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84863975396&partnerID=8YFLogxK

U2 - 10.1200/JCO.2011.38.4099

DO - 10.1200/JCO.2011.38.4099

M3 - Article

VL - 30

SP - 2102

EP - 2111

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 17

ER -