Does Smoking Influence Outcomes in Human Papillomavirus—Associated Oropharyngeal Cancer Treated with Transoral Robotic Surgery?

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OBJECTIVE: Smoking has been identified as a risk factor for recurrence in HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) treated with definitive chemoradiation. Whether the same prognostic significance holds with surgical treatment such as transoral robotic surgery (TORS) is less well studied. STUDY DESIGN: Retrospective review. SETTING: Tertiary care academic center. METHODS: Patients with HPV-associated OPSCC treated with TORS from January 2016 to December 2023 were included. Demographics, smoking history, disease characteristics, treatment, and oncologic outcomes were collected. RESULTS: 156 patients were included. 87.2% were male with median age 60.0 years. Seventy-seven were never smokers, 63 former smokers, and 16 current smokers, with a median 20 pack-years among ever smokers. Three local, 6 regional, and ten distant metastases were identified, with 6 deaths, over a median 2.2 years of follow up. When comparing never, former, and current smokers, ever smokers demonstrated more advanced pathologic nodal staging (P = .03) and extranodal extension (P = .05). When comparing never and ever smokers, never smokers were younger (P = .04), and primary site differed with borderline significance (P = .05). Ever smokers again had more advanced nodal stage (P = .01) and extranodal extension (P = .02). There were no significant differences in adjuvant treatment, disease recurrence, or death by smoking history. There were no significant differences apart from age when analyzed using a 10 or 20-pack-year smoking history cutoff (P = .01, P = .02). CONCLUSION: Smoking history is associated with more advanced nodal stage and extranodal extension. However, smoking does not appear to influence recurrence or death in the setting of HPV-associated OPSCC definitively treated with TORS.

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