Complex Etiology Underlies Risk and Survival in Head and Neck Cancer Human Papillomavirus, Tobacco, and Alcohol: A Case for Multifactor Disease
Table 3
Site-specific head and neck cancer stratified by HPV E6/E7, tobacco, and alcohol status.1
Cases
Controls
Oral cavity versus controls
Oropharynx versus controls
Oral cavity
Oropharynx
OR (95% CI)
OR (95% CI)
HPV E6/E72
Risk factor
(%)
(%)
(%)
Tobacco3
Negative
Never
54 (32.0)
2 (2.7)
150 (35.3)
1.0
1.0
≤30
41 (24.3)
6 (8.2)
127 (29.9)
0.9 (0.6–1.5)
3.2 (0.6–16.6)
>30
58 (34.3)
19 (26.0)
119 (28.0)
1.4 (0.8–2.3)
11.0 (2.4–51.7)
test for trend value
0.19
<0.0001
Positive
Never
3 (1.8)
8 (11.0)
10 (2.4)
1.0
1.0
≤30
3 (1.8)
19 (26.0)
15 (3.5)
0.3 (0.03–2.4)
1.4 (0.4–4.9)
>30
10 (5.9)
19 (26.0)
4 (0.9)
3.5 (0.5–26.9)
4.7 (1.03–21.7)
test for trend value
0.008
0.01
Alcohol4
Negative
Never
57 (33.7)
2 (2.7)
170 (39.9)
1.0
1.0
≤21
54 (32.0)
10 (13.7)
166 (39.0)
1.1 (0.7–1.8)
5.4 (1.1–25.7)
>21
42 (24.8)
15 (20.6)
59 (13.9)
3.1 (1.7–5.5)
24.3 (4.9–121.3)
test for trend value
0.009
<0.0001
Positive
Never
3 (1.8)
6 (8.2)
14 (3.3)
1.0
1.0
≤21
5 (3.0)
27 (37.0)
15 (3.5)
1.2 (0.2–7.3)
4.1 (1.2–14.7)
>21
8 (4.7)
13 (17.8)
2 (0.5)
9.8 (0.9–106.9)
8.5 (1.2–60.2)
test for trend value
0.002
0.001
Tobacco/alcohol5
Negative
Never/never
40 (23.8)
1 (1.4)
93 (22.0)
1.0
1.0
≤30/≤21
21 (12.5)
1 (1.4)
63 (14.9)
1.0 (0.5–1.9)
1.9 (0.1–31.1)
≤30/>21
10 (6.0)
4 (5.5)
24 (5.7)
1.5 (0.6–3.6)
22.8 (2.2-235.2)
>30/≤21
20 (11.9)
8 (11.0)
53 (12.5)
1.2 (0.6–2.3)
18.7 (2.2–160.8)
>30/>21
31 (18.4)
11 (15.1)
29 (6.7)
4.0 (2.0–8.3)
56.3 (6.2–512.7)
test for trend value
0.07
<0.0001
Positive
Never/never
2 (1.2)
2 (2.7)
7 (1.7)
1.0
1.0
≤30/≤21
2 (1.2)
13 (17.8)
9 (2.1)
0.7 (0.04–12.0)
8.9 (0.96–82.9)7
≤30/>21
0 (0.0)
4 (5.5)
2 (0.5)
0.6 (0.02–17.2) 6
13.7 (0.8–227.9)
>30/≤21
2 (1.2)
9 (12.3)
2 (0.5)
2.6 (0.1–67.4)
29.3 (2.1–408.7)7
>30/>21
8 (4.8)
8 (11.0)
0 (0.0)
55.0 (0.8–3651.0)6,7
18.3 (0.5–627.2)6,7
test for trend -value
0.008
0.001
1Percentages based on available data; 2HPV E6/E7 seronegative for HPV-16, -18, and/or -33; HPV E6/E7 seropositive for HPV-16, -18, and/or -33; 3adjusted for age (continuous), gender, and average drinks/week (continuous); 4adjusted for age (continuous), gender, and tobacco pack-years (continuous); 5adjusted for age (continuous) and gender, all never groups combined with never/never as reference group; 6Logit estimator, 0.5 is added to zero cells; 7CMH -value < 0.049.
