Association of Human Papillomavirus Status at Head and Neck Carcinoma Subsites With Overall Survival

Li, Hong; Torabi, Sina J.; Yarbrough, Wendell G.; Mehra, Saral; Osborn, Heather A.; Judson, Benjamin L.

doi:10.1001/jamaoto.2018.0395

Cited by 117 publications

(122 citation statements)

References 51 publications

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“…This may indicate that current testing practices have led to elevated rates of HPV‐positive tumor detection due to a selection bias. In addition, it could explain why previously reported rates of HPV‐positive SNSCC, for the most part, have been higher than the incidence we observed (20%‐62%) …”

Section: Discussioncontrasting

confidence: 55%

“…NCDB HPV data are gathered from pathology reports (immunohistochemical staining) and molecular analyses that specify the HPV type identified. 22 From these initial reports, HPV status was categorized as positive for high-risk HPV types (types 16,18,26,31,33,35,36,45,51,52,53,56,58,59,66,67,68,69,70,73, 82, and 85), low-risk HPV types (types 6,11,32,34,40,42,44,54,61,62,64,71,72,74,81,83,84,87, and 89), and unknown HPV types (incomplete data); negative for HPV; or unknown. In the current study, patients were classified as having HPV-positive disease only if they tested positive for high-risk HPV types or were documented as having "high-risk types NOS [not otherwise specified]," and as having HPV-negative disease if they had a negative HPV test result.…”

Section: Methodsmentioning

confidence: 99%

“…In part due to the low incidence of SNSCC, lower rates of HPV testing, and smaller percentage of HPV‐positive tumors, the literature regarding the prognostic role of HPV in SNSCC has been particularly limited; the majority of previous studies have analyzed relatively small cohorts, with <40 HPV‐positive cases . The literature that has been published to date has formed mixed conclusions, with some studies reporting HPV‐related SNSCC to be associated with improved outcomes, whereas other studies have not found HPV status to be a significant prognostic factor . It is interesting to note that the 2 previous studies that reported HPV‐positive SNSCC to be associated with improved outcomes had somewhat limited multivariable models that did not adjust for TNM stage as well as other clinicopathologic factors correlated with HPV‐positive SNSCC .…”

Section: Introductionmentioning

confidence: 99%

“…5,6,17 The literature that has been published to date has formed mixed conclusions, with some studies reporting HPV-related SNSCC to be associated with improved outcomes, whereas other studies have not found HPV status to be a significant prognostic factor. 5,6,17,18 It is interesting to note that the 2 previous studies that reported HPV-positive SNSCC to be associated with improved outcomes had somewhat limited multivariable models that did not adjust for TNM stage as well as other clinicopathologic factors correlated with HPV-positive SNSCC. 5,6 Therefore, contrary to oropharyngeal tumors, to our knowledge the prognostic value of HPV infection in SNSCC remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Human papillomavirus and survival of patients with sinonasal squamous cell carcinoma

Oliver

Lieberman

Tam

et al. 2019

Cancer

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Background To the authors' knowledge, the question of whether human papillomavirus (HPV) infection is associated with outcomes in patients with sinonasal squamous cell carcinoma (SNSCC) is not well studied at this time. In the current study, the authors investigated patterns of HPV testing and its association with survival in patients with SNSCC using the National Cancer Data Base. Methods The authors selected all SNSCC cases diagnosed between 2010 and 2016. HPV testing practices, clinicodemographic factors, treatments, and survival were analyzed. Multivariable Cox regression and propensity score–matched survival analyses were performed. Results A total of 6458 SNSCC cases were identified. Of these, only 1523 cases (23.6%) were tested for HPV and included in the current study. The median patient age was 64 years and the majority had advanced stage tumors (overall AJCC stage III‐IV, 721 patients; 62.1%). HPV‐positive SNSCC comprised 31.5% (447 of 1418 cases) of the final study cohort. Among 15 hospitals that routinely tested nonoropharyngeal SCCs for HPV, the percentage of HPV‐positive SNSCCs was smaller (24.6%; P = .04). Patients with HPV‐positive SNSCC were younger (aged 60 years vs 65 years; P < .001), with tumors that were more likely to be high grade (55.3% vs 41.7%; P < .001), and attributed to the nasal cavity (62.2% vs 44.0%; P < .001). HPV‐positive SNSCC was associated with significantly improved overall survival in multivariable regression analysis (hazard ratio, 0.45; 95% CI, 0.28‐0.72 [P = .001]) and propensity score–matched (hazard ratio, 0.61; 95% CI, 0.38‐0.96 [P = .03]) analyses controlling for clinicodemographic and treatment factors. Conclusions Currently, only a minority of patients with SNSCC are tested for HPV. However, a sizable percentage of SNSCC cases may be HPV related; furthermore, HPV‐positive SNSCC is associated with improved overall survival. Routine HPV testing may be warranted in patients with SNSCC.

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Section: Discussioncontrasting

confidence: 55%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Human papillomavirus and survival of patients with sinonasal squamous cell carcinoma

Oliver

Lieberman

Tam

et al. 2019

Cancer

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“…The incidence of oropharynx squamous cell carcinoma (OPSCC) has been rising rapidly due to the human papillomavirus (HPV) as the driving carcinogenic agent. With the excellent 2‐ and 5‐year overall survival (>90% and ~80%, respectively) and increased life expectancy in the HPV‐positive OPSCC population, patients are at risk for developing long‐term opioid use as a result from their disease and treatment . HPV‐negative OPSCC patients are also at increased risk for chronic opioid use, as they often present with advanced‐stage disease, comorbid medical conditions with a high symptom burden, and a poor survival prognosis.…”

Section: Introductionmentioning

confidence: 99%

Chronic opioid use in patients undergoing treatment for oropharyngeal cancer

Silver

Dourado

Hitchcock³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis Head and neck cancer pain is a prevalent problem, and the current opioid crisis has highlighted concerns raised in chronic pain management. This study assessed the characteristics of opioid use in patients undergoing treatment for oropharynx cancer and identified risk factors associated with chronic opioid use. Study Design Retrospective cohort study. Methods A study was conducted of 198 eligible patients who underwent radiotherapy as part of their treatment for oropharynx cancer at a single institution from 2012 to 2017. p16/human papillomavirus (HPV) status was determined by pathology report review. Opioid use was recorded. Statistical analysis was performed to assess risk factors for chronic opioid use and effect on overall survival. Results The average age was 62 years, and the mean follow‐up was 38 months. Eighty‐three percent of patients had stage III/IV disease, and 73% received chemoradiotherapy. Sixty‐nine percent were HPV/p16 positive. Fifty‐seven (29%) patients had preexisting chronic pain conditions. Chronic opioid use was observed in 53% of the patients. Age ≤ 62 years (P < .0001), history of depression (P = .0356), p16 negative status (P = .0097), opioid use at pretreatment visit (P = .0021), and presence of a preexisting chronic pain condition at time of diagnosis (P = .0181) were associated with chronic opioid use using univariate analysis. On multivariate analysis, T stage and anxiety/depression were associated with chronic opioid use. Overall survival was worse for patients who had chronic opioid use, but was not significant when recurrence was taken into consideration. Conclusions More than 50% of the patients treated for oropharynx squamous cell carcinoma in this cohort were chronic opioid users after treatment. Identifying patients at greatest risk for chronic opioid use prior to treatment may help with long‐term pain management in this patient population. Level of Evidence 4 Laryngoscope, 129:2087–2093, 2019

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