Rethinking the 10-pack-year rule for favorable human papillomavirus-associated oropharynx carcinoma: A multi-institution analysis.

Autor: Broughman JR; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio., Xiong DD; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio., Moeller BJ; Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Contrera KJ; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio., Prendes BL; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio., Lamarre ED; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio., Ku JA; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio., Burkey BB; Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio., Woody NM; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio., Joshi NP; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio., Adelstein DJ; Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio., Geiger JL; Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio., Frenkel CH; Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Milas ZL; Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Brickman DS; Department of Surgical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Sumrall AL; Department of Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Carrizosa DR; Department of Medical Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Greskovich JF; Department of Radiation Oncology, Cleveland Clinic Florida, Weston, Florida., Koyfman SA; Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio., Ward MC; Department of Radiation Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2020 Jun 15; Vol. 126 (12), pp. 2784-2790. Date of Electronic Publication: 2020 Mar 13.
DOI: 10.1002/cncr.32849
Abstrakt: Background: 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.
Methods: 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).
Results: 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%.
Conclusions: 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.
(© 2020 American Cancer Society.)
Databáze: MEDLINE
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