Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;129(11):2506-2513.
doi: 10.1002/lary.27807. Epub 2019 Jan 13.

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

Eugenie Du  1 , Angela L Mazul  2 , Doug Farquhar  1 , Paul Brennan  3 , Devasena Anantharaman  3   4 , Behnoush Abedi-Ardekani  3 , Mark C Weissler  1   5 , David N Hayes  6   7 , Andrew F Olshan  1   5   6 , Jose P Zevallos  2   6
Affiliations

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

Eugenie Du et al. Laryngoscope. 2019 Nov.

Abstract

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, 129:2506-2513, 2019.

Keywords: Head and neck neoplasms; human papillomavirus; oropharynx; smoking; survival.

PubMed Disclaimer

Conflict of interest statement

The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Figures

Fig. 1.
Fig. 1.
Flowchart of patient selection and stratification. CHANCE = Carolina Head and Neck Cancer Study; HNSCC = head and neck squamous cell carcinoma; HP = hypopharynx; HPV = human papillomavirus; NOS = not otherwise specified; OC = oral cavity; OP = otopharyngeal; OPSCC = oropharyngeal squamous cell carcinoma.
Fig. 2.
Fig. 2.
Long-term overall survival of all head and neck squamous cell carcinoma patients alive 5 years after diagnosis stratified by tumor site (A) and initial overall stage (B) compared to age-matched controls. Weighted survival curve by tumor site (C) and by initial survival stage (D) adjusting group to control in terms of age, race, and smoking status. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]
Fig. 3.
Fig. 3.
Overall survival of (A) non–HPV-associated HNSCC and (B) HPV-associated OPSCC cases after 5 years stratified by smoking status (<10 pack-years vs. >10 pack-years) with associated 10-year OS and HRs. HRs indicate risk of death of cases when compared to controls with the same smoking status. CI = confidence interval; HNSCC = head and neck squamous cell carcinoma; HPV = human papillomavirus; HR = hazard ratio; OPSCC = oropharyngeal squamous cell carcinoma; OS = overall survival. [Color figure can be viewed in the online issue, which is available at www.laryngoscope.com.]
See this image and copyright information in PMC

References

    1. Fitzmaurice C, Allen C, Barber RM, et al. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 2017;3:524–548. - PMC - PubMed
    1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017;67:7–30. - PubMed
    1. Hoffman HT, Karnell LH, Funk GF, Robinson RA, Menck HR. The National Cancer Data Base report on cancer of the head and neck. Arch Otolaryngol Head Neck Surg 1998;124:951–962. - PubMed
    1. Boysen M, Natvig K, Winther FO, Tausjo J. Value of routine follow-up in patients treated for squamous cell carcinoma of the head and neck. J Otolaryngol 1985;14:211–214. - PubMed
    1. Blot WJ, McLaughlin JK, Winn DM, et al. Smoking and drinking in relation to oral and pharyngeal cancer. Cancer Res 1988;48:3282–3287. - PubMed

Publication types

MeSH terms