Impact of Smoking on Survival Outcomes in HPV-Related Oropharyngeal Carcinoma: A Meta-analysis

Ryan Ference, David Liao, Qi Gao, Vikas Mehta

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Objective: Characterize the survival impact of smoking on HPV-related (human papillomavirus) oropharyngeal squamous cell carcinoma. Data Sources: Articles from 2000 to 2019 in the PubMed, Embase, and Cochrane Library databases were systematically reviewed for content and inclusion/exclusion criteria. Review Methods: Two reviewers independently analyzed the databases for eligibility and quality of the articles. Demographic data, smoking history, and survival outcomes were recorded. Hazard ratios and 95% CIs were collectively analyzed through a random effects meta-analysis model. Results: Fifteen articles were included in the meta-analysis for overall survival, disease-specific survival, disease-free survival, progression-free survival, and locoregional recurrence outcomes. The overall survival hazard ratio was 2.4 for ever having smoked (95% CI, 1.4-4.0; P =.0006, I2 =.384) and 3.2 for current smoking (95% CI, 2.2-4.6; P <.0001, I2 = 0). The hazard ratio for disease-specific survival in current smokers was 6.3 (95% CI, 1.3-29.3; P =.0194, I2 = 0). Ever smoking had a larger impact on overall survival and disease-specific survival than the 10–pack year smoking threshold. Conclusion: Smoking negatively affects survival in patients with HPV-related oropharyngeal carcinoma across all outcomes. Current smoking during treatment is associated with the greatest reduction in survival, possibly secondary to diminished radiation therapy efficacy.

Original languageEnglish (US)
Pages (from-to)1114-1122
Number of pages9
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number6
StatePublished - Dec 2020


  • HPV
  • oropharyngeal carcinoma
  • smoking
  • survival outcomes

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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