Cause‐specific mortality in HPV+ and HPV− oropharyngeal cancer patients: insights from a population‐based cohort

Abstract

Identifying the causes of death in head and neck cancer patients can optimize follow‐up and therapeutic strategies, but studies in oropharyngeal squamous cell carcinoma (OPSCC) patients stratified by HPV status are lacking. We report cause‐specific mortality in a population‐based cohort of patients with OPSCC. Patients who had been diagnosed with OPSCC (n = 1541) between 2000 and 2014 in eastern Denmark were included in the study. Causes of death were collected through medical files and the Danish National Cause of Death registry. Deaths were grouped as (1) primary oropharyngeal cancer, (2) secondary malignancies, (3) cardiovascular and pulmonary disease, or (4) other/unspecified. The cumulative incidence of death and specific causes of death were determined using risk analysis. At follow‐up, 723 (47.5%) patients had died. The median time to and cause of death were determined: oropharyngeal cancer (n = 432; 1.00 year), secondary malignancies (n = 131; 2.37 years), cardiovascular and pulmonary causes (n = 58; 3.48 years), and unspecified causes (n = 102; 3.42 years). HPV/p16 status was the strongest predictor of improved survival across all causes of death. The only cause of death to decrease in incidence over the 2 years after treatment was death from OPSCC. HPV/p16 positivity was an independent factor for improved survival across all causes of death in patients with OPSCC. In addition, both HPV‐positive and HPV‐negative OPSCC patients faced high 5‐ and 10‐year mortality rates. Implementing secondary screening and prevention strategies for late toxicity and mortality are major goals in managing the treatment of these patients.

Comparison of the Tree-Based Machine Learning Algorithms to Cox Regression in Predicting the Survival of Oral and Pharyngeal Cancers: Analyses Based on SEER Database

“…The main limitation of this study is the lack of records of other well-known predictors for OPCs survival in the SEER program. For example, for patients with oropharyngeal squamous cell carcinoma, individuals with human papillomavirus (HPV) positive status are likely to have better prognosis than their HPV-negative counterparts [ 28 ]. Therefore, it is worth noting that including HPV information and other prognostic factors such as smoking, alcohol consumption and chemotherapy [ 29 ] are likely to modify the models’ predictive ability.…”

Competing mortality in oropharyngeal carcinoma according to human papillomavirus status

“…Nørregaard et al were the first to analyze cause‐specific mortality as a function of HPV status in OPC. The authors carried out a population‐based cohort study including 1521 patients with OPC treated from 2000 to 2014 in eastern Denmark.…”

“…There is strong evidence that patients with HPV‐positive OPC have a better cancer‐specific survival regardless of the treatment modality received . However, few studies have analyzed the competing causes of death in patients with OPC depending on the HPV status …”

Impact on survival of tobacco smoking for cases with oropharyngeal squamous cell carcinoma and known human papillomavirus and p16-status: a multicenter retrospective study

“…COD has also been reported in the Danish group; at follow-up 723 (47.5%) patients were deceased. For these cases, the median time to and cause of death were determined: oropharyngeal cancer ( n = 432; 1.00 year), secondary malignancies ( n = 131; 2.37 years), cardiovascular and pulmonary causes ( n = 58; 3.48 years), and unspecified causes ( n = 102; 3.42 years) [17]. It should be noted that the difference in follow-up times for the two cohorts is due to the difference in mortality for the two cohorts, e.g.…”