Impact of Smoking on the Survival of Patients With High-risk HPV-positive HNSCC: A Meta-analysis

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Background/Aim: High risk Human papillomavirus (hr-HPV) and smoking are independant risk factors for head and neck squamous cell carcinomas (HNSCC). While hr-HPV⁺ HNSCC has a better prognosis than smoking-associated HNSCC no systematic data are yet available about the combined risk. Patients and Methods: We performed a meta-analysis to assess the overall survival of HNSCC patients relative to the hr-HPV and smoking status. A literature review up to November 2019 was conducted in PubMed and Cochrane Library using the search terms ‘HPV, Smoking and HNSCC’. Results: Nine out of 748 articles were included, 1,436 out of 2,080 patients were hr-HPV⁺. The prevalence of hr-HPV⁺ smokers was 36%. The meta-analysis showed a significantly better 5-year overall survival for HPV⁺ non-smokers compared to smokers with risk ratio of 1.94 (95% confidence intervaI=1.46-2.58). Conclusion: Smoking is a negative prognostic factor for overall survival in patients with hr-HPV⁺ HNSCC and should thus be an important part of staging and treatment.