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Rethinking the 10-pack-year rule for favorable human papillomavirus-associated oropharynx carcinoma: A multi-institution analysis.
Cancer ( IF 6.2 ) Pub Date : 2020-03-13 , DOI: 10.1002/cncr.32849
James R Broughman 1 , David D Xiong 2 , Benjamin J Moeller 3 , Kevin J Contrera 4 , Brandon L Prendes 4 , Eric D Lamarre 4 , Jamie A Ku 4 , Brian B Burkey 4 , Neil M Woody 1 , Nikhil P Joshi 1 , David J Adelstein 5 , Jessica L Geiger 5 , Catherine H Frenkel 6 , Zvonimir L Milas 6 , Daniel S Brickman 6 , Ashley L Sumrall 7 , Daniel R Carrizosa 7 , John F Greskovich 8 , Shlomo A Koyfman 1 , Matthew C Ward 3
Affiliation  

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.

中文翻译:

重新思考有利于人乳头瘤病毒相关的口咽癌的10包年规则:多机构分析。

背景技术早期人类乳头瘤病毒阳性(HPV +)口咽癌(OPC)的强化治疗策略依赖于选择预后良好的患者。当前的减强度试验的入选标准为≤10个包装年。包年标准的更多细微差别可以扩大入组人数,改善患者预后并防止过度治疗。据推测,如果戒烟成功,超过10个包装年的患者可能会出现良好的预后。方法从机构审查委员会批准的数据库中,回顾性确定明确接受放射线治疗并伴或不伴化疗的HPV +口咽鳞状细胞癌患者。纳入有吸烟史且符合国家降血脂试验条件的患者(cT1-2N1-2b或T3N0-2b [美国癌症联合委员会,第七版])。使用带有惩罚平滑平滑样条的Cox回归来评估戒烟的非线性影响。递归分区分析(RPA)用于客观地搜索2个共线性变量(包装年数和停止后的时间)之间的关系。结果在符合入选标准的330例患者中,从未吸烟者130例(40%),曾经吸烟者139例(42%)和当前吸烟者61例(18%)。通过标准疗法,所有前吸烟者的无进展生存率(PFS)均高于91%,无论包年暴露如何。非线性Cox回归表明,即使在≤20个包装年的人群中,近期戒烟与更严重的PFS也相关。RPA显示,只有目前的吸烟者2年PFS率低于91%。以前的吸烟者,无论烟酒年限如何,其2年PFS率均高于91%。结论10包年规则可能不适用于所有早期的HPV + OPC,尤其是对于以前的吸烟者。在确定吸烟状况的预测性作用之前,未来的随机减量试验应考虑采用更广泛,更细微的方法。结论10包年规则可能不适用于所有早期的HPV + OPC,尤其是对于以前的吸烟者。在确定吸烟状况的预测作用之前,未来的随机减量试验应考虑采用更广泛,更细微的方法。结论10包年规则可能不适用于所有早期的HPV + OPC,尤其是对于以前的吸烟者。在确定吸烟状况的预测作用之前,未来的随机减量试验应考虑采用更广泛,更细微的方法。
更新日期:2020-03-13
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