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Long-Term Survival in Head and Neck Cancer: Impact of Site, Stage, Smoking, and Human Papillomavirus Status


Du, Eugenie; Mazul, Angela L.; Farquhar, Douglas R.; Brennan, Paul; Anantharaman, Devasena; Abedi-Ardekani, Behnoush; Weissler, Mark Christian; Hayes, D. Neil; Olshan, Andrew F.; & Zevallos, Jose P. (2019). Long-Term Survival in Head and Neck Cancer: Impact of Site, Stage, Smoking, and Human Papillomavirus Status. Laryngoscope, 129(11), 2506-2513. PMCID: PMC6907689


OBJECTIVES/HYPOTHESIS: Literature examining long-term survival in head and neck squamous cell carcinoma (HNSCC) with human papillomavirus (HPV) status is lacking. We compare 10-year overall survival (OS) rates for cases to population-based controls.
STUDY DESIGN: Prospective cohort study.
METHODS: Cases surviving 5 years postdiagnosis were identified from the Carolina Head and Neck Cancer Study. We examined 10-year survival by site, stage, p16, and treatment using Kaplan-Meier and Cox proportional hazard models. Cases were compared to age-matched, noncancer controls with stratification by p16 and smoking status.
RESULTS: Ten-year OS for HNSCC is less than controls. In 581 cases, OS differed between sites with p16+ oropharynx having the most favorable prognosis (87%), followed by oral cavity (69%), larynx (67%), p16- oropharynx (56%), and hypopharynx (51%). Initial stage, but not treatment, also impacted OS. When compared to controls matched on smoking status, the hazard ratio (HR) for death in p16+ oropharynx cases was 1.5 (95% confidence interval [CI]: 0.7-3.1) for smokers and 2.4 (95% CI: 0.7-8.8) for nonsmokers. Similarly, HR for death in non-HPV-associated HNSCC was 2.2 (95% CI: 1.7-3.0) for smokers and 2.4 (95% CI: 1.4-4.9) for nonsmokers.
CONCLUSIONS: OS for HNSCC cases continues to decrease 5 years posttreatment, even after stratification by p16 and smoking status. Site, stage, smoking, and p16 status are significant factors. These data provide important prognostic information for HNSCC.
LEVEL OF EVIDENCE: 2 Laryngoscope, 2019.


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Journal Article

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Journal Title



Du, Eugenie
Mazul, Angela L.
Farquhar, Douglas R.
Brennan, Paul
Anantharaman, Devasena
Abedi-Ardekani, Behnoush
Weissler, Mark Christian
Hayes, D. Neil
Olshan, Andrew F.
Zevallos, Jose P.