The impact of smoking and p16 status on small pulmonary nodules in head and neck cancer: a pilot study.
Miss. J. Langschmidt, Mark Macmillan, Mr. R. Green, Prof. J. Murchison, Mr. I. J. Nixon
Special thanks to Chris Curtis – The Swallows Charity
The interpretation and management of small pulmonary nodules in the context of head and neck cancer can be challenging. Traditionally radiological factors have been used to assess the risk of malignancy associated with nodules however tumor and patient specific factors may also be important.
Do smoking and Human Papilloma Virus (HPV) status affect the risk of malignancy in small pulmonary nodules in patients with head and neck cancer
Data was collected on smoking and p16 staining for HPV status in 69 cases from a previous study involving 400 head and neck cancer patients. Staging CT chest examinations were examined to identify small pulmonary nodules
45 of the 69 patients included in this study had pulmonary nodules on initial staging CT. Of 42 current smokers at the time of studying 26 had pulmonary nodules (62%), in non or previous smokers 8 of 27 patients had nodules (30%). In patients with p16 positive malignancy 23 of 37 had pulmonary nodules (62%); in p16 negative cases,22 of 32 (69%), p=0.567. In 3 patients malignancy developed from a small pulmonary nodule, all of which occurred in current or ex-smokers. 1 of the 3 incidences of malignancy from a small pulmonary nodule occurred in a patient with p16 positive primary cancer.
The relationship between p16 status and small pulmonary nodules remains unclear. We plan to carry out a prospective cohort study
Smoking status appears to be an important factor in determining the risk of small pulmonary nodules in the context of head and neck cancer.