Complex Etiology Underlies Risk and Survival in Head and Neck Cancer Human Papillomavirus, Tobacco, and Alcohol: A Case for Multifactor Disease

Table 4

Tobacco and alcohol status in head and neck cancer cases by HPV E6/E7 ^1,2 and tumor HPV status¹ (𝑁=204).

Risk factor	E6/E7 positive	E6/E7 negative	OR (95% CI)	Tumor positive^3	Tumor negative^3	OR (95% CI)
	N (%)	N (%)		N (%)	N (%)
Prevalence	52 (25.5)	152 (74.5)		53 (26.0)	151 (74.0)
Tumor site
Oral cavity	14 (26.9)	131 (86.2)	1.0	19 (35.9)	126 (83.4)	1.0
Oropharynx	38 (73.1)	21 (13.8)	17.3 (7.4–40.5)	34 (64.2)	25 (16.6)	8.8 (4.1–19.0)
Tobacco^4
Never	8 (15.7)	49 (32.5)	1.0	9 (17.3)	48 (32.0)	1.0
≤30	20 (39.2)	37 (24.5)	2.1 (0.8–5.7)	23 (44.2)	34 (22.7)	3.0 (1.2–7.5)
>30	23 (45.1)	65 (43.0)	1.1 (0.4–3.1)	20 (38.5)	68 (45.3)	1.2 (0.5–3.4)
≤30 versus >30			1.9 (0.8–4.2)			2.3 (1.1–5.1)
Alcohol^5
Never	7 (13.7)	51 (33.6)	1.0	8 (15.4)	50 (33.1)	1.0
≤21	24 (47.1)	56 (36.8)	2.3 (0.8–6.2)	27 (51.9)	53 (35.1)	3.0 (1.2–7.8)
>21	20 (39.2)	45 (29.6)	2.1 (0.7–6.4)	17 (32.7)	48 (31.8)	2.2 (0.7–6.8)
≤21 versus >21			1.1 (0.5–2.5)	3 (5.8)	10 (6.7)	1.3 (0.6–3.0)
Tobacco/alcohol^6
Never//never	4 (7.8)	38 (25.2)	1.0			1.0
≤30/≤21	13 (25.5)	21 (13.9)	3.2 (0.9–12.0)	15 (28.9)	19 (12.7)	4.2 (1.2–14.0)
≤30/>21	4 (7.8)	10 (6.6)	1.8 (0.3–9.3)	5 (9.6)	9 (6.0)	2.6 (0.6–11.8)
>30/≤21	8 (15.7)	24 (15.9)	1.6 (0.4–6.7)	9 (17.3)	23 (15.3)	1.9 (0.5–6.8)
>30/>21	15 (29.4)	34 (22.5)	1.6 (0.4–5.9)	11 (21.2)	38 (25.3)	1.2 (0.3–4.2)

¹Percentages based on available data; ²HPV E6/E7 seronegative for HPV-16, and -33; HPV E6/E7 seropositive for HPV-16 and/or -33; ³DNA negative for all HPV DNA types; DNA positive for HPV-16 and/or -33; ⁴adjusted for age (continuous), gender, tumor site (oral cavity, oropharynx), and average drinks/week (continuous); ⁵adjusted for age (continuous), gender, tumor site (oral cavity, oropharynx), and tobacco pack-years (continuous); ⁶adjusted for age (continuous) and gender.