{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T14:54:50Z","timestamp":1787496890239,"version":"build-2736575974"},"reference-count":46,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"17","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2012,6,10]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Tobacco smoking is associated with oropharynx cancer survival, but to what extent cancer progression or death increases with increasing tobacco exposure is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>Patients with oropharynx cancer enrolled onto a phase III trial of radiotherapy from 1991 to 1997 (Radiation Therapy Oncology Group [RTOG] 9003) or of chemoradiotherapy from 2002 to 2005 (RTOG 0129) were evaluated for tumor human papillomavirus status by a surrogate, p16 immunohistochemistry, and for tobacco exposure by a standardized questionnaire. Associations between tobacco exposure and overall survival (OS) and progression-free survival (PFS) were estimated by Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Prevalence of p16-positive cancer was 39.5% among patients in RTOG 9003 and 68.0% in RTOG 0129. Median pack-years of tobacco smoking were lower among p16-positive than p16-negative patients in both trials (RTOG 9003: 29 v 45.9 pack-years; P = .02; RTOG 0129: 10 v 40 pack-years; P &lt; .001). After adjustment for p16 and other factors, risk of progression (PFS) or death (OS) increased by 1% per pack-year (for both, hazard ratio [HR], 1.01; 95% CI, 1.00 to 1.01; P = .002) or 2% per year of smoking (for both, HR, 1.02; 95% CI, 1.01 to 1.03; P &lt; .001) in both trials. In RTOG 9003, risk of death doubled (HR, 2.19; 95% CI, 1.46 to 3.28) among those who smoked during radiotherapy after accounting for pack-years and other factors, and risk of second primary tumors increased by 1.5% per pack-year (HR, 1.015; 95% CI, 1.005 to 1.026).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Risk of oropharyngeal cancer progression and death increases directly as a function of tobacco exposure at diagnosis and during therapy and is independent of tumor p16 status and treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1200\/jco.2011.38.4099","type":"journal-article","created":{"date-parts":[[2012,5,8]],"date-time":"2012-05-08T03:18:05Z","timestamp":1336447085000},"page":"2102-2111","source":"Crossref","is-referenced-by-count":431,"title":["Tobacco Smoking and Increased Risk of Death and Progression for Patients With p16-Positive and p16-Negative Oropharyngeal Cancer"],"prefix":"10.1200","volume":"30","author":[{"given":"Maura L.","family":"Gillison","sequence":"first","affiliation":[{"name":"Maura L. Gillison and Weihong Xiao, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Qiang Zhang and Jonathan Harris, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Richard Jordan, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William H. Westra and Christine H. Chung, Johns Hopkins Hospital, Baltimore, MD; Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Sharon Spencer,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Maura L. Gillison and Weihong Xiao, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Qiang Zhang and Jonathan Harris, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Richard Jordan, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William H. Westra and Christine H. Chung, Johns Hopkins Hospital, Baltimore, MD; Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Sharon Spencer,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Jordan","sequence":"additional","affiliation":[{"name":"Maura L. Gillison and Weihong Xiao, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Qiang Zhang and Jonathan Harris, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Richard Jordan, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William H. Westra and Christine H. Chung, Johns Hopkins Hospital, Baltimore, MD; Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Sharon Spencer,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weihong","family":"Xiao","sequence":"additional","affiliation":[{"name":"Maura L. Gillison and Weihong Xiao, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Qiang Zhang and Jonathan Harris, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Richard Jordan, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William H. Westra and Christine H. Chung, Johns Hopkins Hospital, Baltimore, MD; Andy Trotti, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL; Sharon Spencer,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William H.","family":"Westra","sequence":"additional","affiliation":[{"name":"Maura L. Gillison and Weihong Xiao, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Qiang Zhang and Jonathan Harris, Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA; Richard Jordan, University of California at San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; William H. 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