Kompelli AR, et al. - Authors evaluated the effect of pathologic features and chronic tobacco use on human papillomavirus (HPV)–related oropharyngeal squamous cell carcinoma (OPSCC). They treated a total of 301 patients OPSCC from 2008 to 2016. The potential need for more aggressive therapy for HPV-positive patients with extensive tobacco use under the new staging system was highlighted in this series. Findings suggested association of the presence of extranodal extension (ENE) with a significantly decreased 5-year survival in heavy smokers relative to nonsmokers in HPV-positive patients.