Human papillomavirus (HPV) has been associated with head and neck squamous cell carcinomas (HNSCC), especially of the oropharynx, with highest distribution in the tonsils. HPV infection has been associated with improved outcome, although not all the studies show consistent results. The reason for this is not clear. We reviewed all published articles and conducted a meta-analysis on the overall relationship between HPV infection and overall survival (OS) and disease-free survival (DFS) in HNSCC. Patients with HPV-positive HNSCC had a lower risk of dying (meta HR: 0.85, 95% CI: 0.7-1.0), and a lower risk of recurrence (meta HR: 0.62, 95%CI: 0.5-0.8) than HPV-negative HNSCC patients. Sitespecific analyses show that patients with HPV-positive oropharyngeal tumours had a 28% reduced risk of death (meta HR: 0.72, 95%CI: 0.5-1.0) in comparison to patients with HPV-negative oropharyngeal tumours. Similar observations were made for DFS (meta HR: 0.51, 95% CI: 0.4-0.7). There was no difference in OS between HPV-positive and negative non-oropharyngeal patients. The observed improved OS and DFS for HPV-positive HNSCC patients is specific to the oropharynx; these tumours may have a distinct etiology from those tumours in non-oropharyngeal sites. ' 2007 Wiley-Liss, Inc.Key words: HPV; overall survival; disease-free survival; head and neck cancerThe majority of head and neck tumours are differentiated squamous cell carcinomas (SCC), which occur in the oral cavity, oropharynx, hypopharynx and larynx. Approximately 45,660 new cases and 11,210 deaths from cancers of the oral cavity, pharynx and larynx are expected in the United States in 2007.1 The 5-year relative age-adjusted survival rate for these head and neck sites was 58% between 1973 and 2002 (58% for males and 60% for females), 2 and have remained unchanged for more than 3 decades. This poor survival rate is primarily due to the late stage of diagnosis, and to a high frequency of recurrence and second primary tumours. [3][4][5][6][7] Human papillomavirus (HPV) is associated with the development of most anogenital carcinomas, including cervical cancer and, has more recently been suggested to be a risk factor for a subset of head and neck squamous cell carcinoma (HNSCC).8 Most HPV-associated HNSCC tend to occur in the oropharynx, with highest distribution in the tonsils. HPV16 is the predominant genotype detected in head and neck tumours, with different prevalence between head and neck subsites. A recent review of the prognostic significance of HPV in survival of head and neck cancer patients has shown that the majority of studies have reported better survival in patients with HPV-positive head and neck tumours when compared to patients with HPV-negative tumours.9 However, the same review also reported that in some studies, HPV infection resulted in a worse prognosis or had no influence on prognosis.We have reviewed all published articles that have addresses the impact of HPV infection on the outcome of patients with HNSCC, and have also conducted a meta-analysis of the pub...

Patients 80 years or older account for 14% (70 years or older accounted for 47%) of all lung cancers, are less likely to be subjected to surgery or radiation, and have inferior outcomes when compared with younger patients.

Head and neck cancer was the eighth leading cause of cancer death worldwide in 2000. Although the incidence of head and neck squamous cell carcinoma (HNSCC) in the United States is relatively low, survival is poor and has not improved for several decades. While tobacco and alcohol are the primary risk factors for HNSCC development, epidemiological studies report a strong association with human papillomavirus (HPV) in a subset of HNSCC. More than 95% of cervical squamous cell carcinomas are linked to persistent HPV infection; evidence demonstrates that HPV is a necessary carcinogen. Not all HPV-positive HNSCC express the viral oncogenes (E6 and E7), which suggests that HPV may function as a carcinogen in a smaller proportion of HNSCC. This review presents our current understanding of the relationship between HPV and HNSCC, and describes future research directions that may lead to a better understanding of the involvement of HPV in head and neck cancer.