Long-term Survival in Head and Neck Cancer: Impact of Site, Stage, Smoking, and Human Papillomavirus Status

Eugenie Du, Angela L. Mazul, Doug Farquhar, Paul Brennan, Devasena Anantharaman, Behnoush Abedi-Ardekani, Mark C. Weissler, David N. Hayes, Andrew F. Olshan, Jose P. Zevallos

Research output: Contribution to journalArticlepeer-review

89 Scopus citations


Objectives/Hypothesis: Literature examining long-term survival in head and neck squamous cell carcinoma (HNSCC) with human papillomavirus (HPV) status is lacking. We compare 10-year overall survival (OS) rates for cases to population-based controls. Study Design: Prospective cohort study. Methods: Cases surviving 5 years postdiagnosis were identified from the Carolina Head and Neck Cancer Study. We examined 10-year survival by site, stage, p16, and treatment using Kaplan-Meier and Cox proportional hazard models. Cases were compared to age-matched, noncancer controls with stratification by p16 and smoking status. Results: Ten-year OS for HNSCC is less than controls. In 581 cases, OS differed between sites with p16+ oropharynx having the most favorable prognosis (87%), followed by oral cavity (69%), larynx (67%), p16− oropharynx (56%), and hypopharynx (51%). Initial stage, but not treatment, also impacted OS. When compared to controls matched on smoking status, the hazard ratio (HR) for death in p16+ oropharynx cases was 1.5 (95% confidence interval [CI]: 0.7-3.1) for smokers and 2.4 (95% CI: 0.7-8.8) for nonsmokers. Similarly, HR for death in non–HPV-associated HNSCC was 2.2 (95% CI: 1.7-3.0) for smokers and 2.4 (95% CI: 1.4-4.9) for nonsmokers. Conclusions: OS for HNSCC cases continues to decrease 5 years posttreatment, even after stratification by p16 and smoking status. Site, stage, smoking, and p16 status are significant factors. These data provide important prognostic information for HNSCC. Level of Evidence: 2 Laryngoscope, 129:2506–2513, 2019.

Original languageEnglish
Pages (from-to)2506-2513
Number of pages8
Issue number11
StatePublished - Nov 1 2019


  • Head and neck neoplasms
  • human papillomavirus
  • oropharynx
  • smoking
  • survival


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