Influence of smoking history on imaging characteristics among patients with human papillomavirus-positive oropharyngeal cancer: A blinded matched-pair analysis

Sarah C. Cantrell, Holly H. Reid, Guojun Li, Qingyi Wei, Erich M. Sturgis, Lawrence E. Ginsberg

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations

Abstract

Background and Purpose: Human papillomavirus (HPV)-positive oropharyngeal cancers represent a distinct clinical entity with more favorable prognosis than do HPV-negative oropharyngeal cancers. However, among patients with HPV-positive oropharyngeal carcinomas, those with a significant smoking history have a much worse prognosis. Recently, imaging characteristics of oropharyngeal cancers were identified as markers of poor prognosis. The purpose of this study was to determine whether nodal imaging characteristics differ between smokers and never/light smokers with HPV-positive oropharyngeal cancer.

Materials and Methods: A review of 130 pretreatment computed tomographic examinations of HPV-positive oropharyngeal cancers in smokers (>10 pack-years) and never/light smokers (≤10 pack-years) matched for T stage and tumor subsite was performed, with the reviewing radiologist blinded to the HPV status, smoking history, and clinical stage. Additionally 24 pretreatment computed tomographic examinations of patients with HPV-negative oropharyngeal cancers were also reviewed in a blinded fashion. Imaging characteristics of metastatic nodal disease were compared using the x2 testing (Fisher exact testing where appropriate) andMcNemar x2 testing for the matched-pair analysis.

Results: As expected, those with HPV-positive oropharyngeal cancer were more likely to be younger, male, non-Hispanic white, never/former smokers, and never drinkers than were those with HPV-negative oropharyngeal cancer. Furthermore, the HPV-positive oropharyngeal cancerswere more likely to be in the tonsil, smaller T category, higherN category, poorly differentiated, than were the HPV-negative oropharyngeal cancers. However, among the HPV-positive oropharyngeal cancers, we could identify no obvious difference in the pretreatment imaging characteristics of paired smokers and never/light smokers.

Conclusions: Among the patients with HPV-positive oropharyngeal cancer, no imaging characteristics were identified to correlate with the critical prognostic feature smoking status. Cystic and necrotic nodal metastases, as described previously, were more common among the patients with HPV-positive than those with HPV-negative oropharyngeal cancers. Although cystic nodal metastases were more common among the never/light smokers with HPV-positive oropharyngeal cancer than among smokers with HPV-positive oropharyngeal cancer, however, because these results did not reach statistical significance, we concluded that the imaging results cannot serve as a surrogate for an HPV-driven phenotype.

Original languageEnglish (US)
Pages (from-to)667-673
Number of pages7
JournalJournal of Computer Assisted Tomography
Volume38
Issue number5
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • Human papillomavirus
  • Oropharyngeal cancer
  • Oropharynx
  • Smoking
  • Tonsil

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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