Impact of human papillomavirus and smoking on survival outcomes after transoral robotic surgery

Background The purpose of this study was to evaluate oncologic outcomes of head and neck squamous cell carcinoma (HNSCC) treated with transoral robotic surgery (TORS) based on human papillomavirus (HPV) and smoking risk factors. Methods Fifty-five patients with HNSCC treated with TORS, neck dissection, +/- adjuvant chemotherapy, and/or radiation therapy were retrospectively analyzed based on HPV and smoking status. Results Smokers and nonsmokers had locoregional control rates of 96.3% and 94.4% (p =.66) and progression-free survival rates 83% and 94.1% (p =.09), respectively. HPV-negative and HPV-positive patients had locoregional control rates of 87.1% and 100% (p =.03) and progression-free survival rates of 74.2% and 95.2% (p =.01), respectively. Locoregional control rates for HPV-negative smokers, HPV-negative nonsmokers, HPV-positive smokers, and HPV-positive nonsmokers were 90.9%, 80.0%, 100%, and 100% (p =.18), whereas progression-free survival rates were 72.2%, 80.0%, 92.3%, and 100% (p =.04), respectively. Conclusion HPV status may be more important than smoking status in determining the risk of disease recurrence and death in patients treated with TORS.