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Smoking history linked to worse survival in HPV-positive oropharyngeal cancer after TORSSmoking History Linked to Worse Survival in Throat Cancer

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Key Takeaway
Smoking history was associated with worse overall survival in HPV-positive OPSCC treated with TORS, but not with significant differences in recurrence or disease-specific survival.

This meta-analysis examined whether smoking history affects outcomes in patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) treated with transoral robotic surgery (TORS). The analysis included 2,079 patients with a median follow-up of 33.7 months.

Smoking history was associated with an increased risk of disease recurrence, with a hazard ratio of 1.4 (95% CI 1.0-2.0). For overall survival, the hazard ratio was 2.7 (95% CI 1.5-4.8), indicating significantly worse survival among patients with a smoking history.

For disease-specific survival, the hazard ratio was 1.4 (95% CI 0.4-4.6), which was not statistically significant. The difference in recurrence-free and disease-specific survival between smokers and non-smokers did not reach significance.

Only five studies reported on overall survival, which limits the strength of these findings. Adverse events, tolerability, funding, and conflicts of interest were not reported. The results are based on observational data, so causality cannot be established.

Clinically, these findings suggest that smoking history may be an important factor in predicting overall survival for patients with HPV-associated OPSCC undergoing TORS, but its impact on recurrence and disease-specific survival remains uncertain.

How this fits prior evidence

This meta-analysis extends the understanding of outcomes for patients undergoing transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell cancer. While prior evidence established that TORS yields oncologic outcomes comparable to radiotherapy in early-stage oropharyngeal cancer, this study adds a specific prognostic factor. It identifies smoking history as a significant factor for overall survival (hazard ratio of 2.7), while noting that its impact on recurrence-free or disease-specific survival was not statistically significant.

Researchers looked at data from over 2,000 patients with HPV-associated oropharyngeal squamous cell cancer. These patients were treated with transoral robotic surgery. The study specifically looked at how a history of smoking affected their recovery and long-term health.

The analysis found that patients with a smoking history had a significantly higher risk of disease recurrence. Most importantly, the data showed a much higher risk of death for those who had smoked in the past. However, the impact of smoking on other measures, such as disease-specific survival, was not found to be statistically significant.

It is important to note that this study was based on observational data, which means it shows a link rather than a direct cause. Additionally, only five studies provided data on overall survival. Patients and doctors should consider these findings as a piece of the larger clinical picture regarding how smoking affects cancer outcomes.

What this means for you:
Smoking history is linked to higher recurrence and lower survival rates in some throat cancer patients.

Common questions

How does smoking affect survival for patients with this type of throat cancer?

The study found that patients with a smoking history had a hazard ratio of 2.7 for overall survival. This indicates a significantly higher risk of death compared to those without a smoking history. However, the impact on disease-specific survival was not found to be statistically significant.

Does smoking increase the risk of the cancer coming back?

Yes, the data showed a hazard ratio of 1.4 for disease recurrence in patients with a smoking history. This suggests that those who have smoked in the past may face a higher risk of the cancer returning after treatment.

What are the limitations of this finding?

The evidence comes from a meta-analysis of observational data, which shows a link rather than a direct cause. Additionally, only five studies provided data on overall survival, which means the evidence for that specific outcome is limited.

Study Details

Study typeMeta analysis
Sample sizen = 2,079
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
OBJECTIVE: While smoking has been implicated as a risk factor for recurrence in HPV-associated oropharyngeal squamous cell cancer (OPSCC) treated with definitive chemoradiation, its prognostic impact on surgically treated OPSCC is less clear. DATA SOURCES: MEDLINE, Embase, CENTRAL, and Scopus. REVIEW METHODS: Articles describing patients with HPV-associated OPSCC treated with transoral robotic surgery (TORS), which reported oncologic outcomes by smoking history, were included. RESULTS: 2079 patients were included across 12 studies. Median age was 58.5 years, and 1808 (87.0%) were male. HPV-associated disease was reported in 1681 (80.9%) patients. T stage was most commonly T2 in 831 (40.0%) and T1 in 764 (36.7%). N stage was N2 in 854 (41.1%), N1 in 544 (26.2%), and N0 in 307 (14.8%). 931 (44.8%) were considered individuals with a smoking history, while 1045 (50.3%) were considered without a smoking history. Median follow up was 33.7 months. Meta-analysis using a fixed effects model demonstrated an overall hazard ratio of 1.4 (95% confidence interval 1.0-2.0) for disease recurrence, 2.7 (95% confidence interval 1.5-4.8) for overall survival, and 1.4 (95% confidence interval 0.4-4.6) for disease specific survival. CONCLUSIONS: In this population of predominantly HPV-associated OPSCC treated with TORS, meta-analysis demonstrated no significant difference in recurrence-free survival or disease-specific survival between individuals with and without a smoking history. Individuals with a smoking history appeared to have worse overall survival, although only five studies reported on this outcome. Further research is required to clarify the prognostic influence of smoking on OPSCC treated with TORS.
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