Comorbidity, human papillomavirus infection and head and neck cancer survival in an ethnically diverse population

Abstract

Objective To demonstrate the importance of comorbid conditions in head and neck squamous cell carcinoma (HNSCC), we assessed the association between comorbidity and survival in an inner-city population of HNSCC patients. Patients and Methods Comorbid status at diagnosis was derived using medical records and the Adult Comorbidity Evaluation-27 (ACE-27) index on 288 patients with histologically confirmed HNSCC from Montefiore Medical Center in the Bronx (NY) between 2002 and 2011. The association between comorbidity, tumor human papillomavirus (HPV) status and overall and disease specific survival was assessed by Kaplan-Meier analysis and multivariable Cox regression adjusting for clinico-pathologic factors. Results The study population consisted of primary oropharyngeal (36%), laryngeal (33%) and oral cavity cancer patients (31%). Overall, 19% had no comorbidity, 43% mild comorbidity, 29% moderate comorbidity, and 9% severe comorbidity. The most common comorbid conditions were hypertension, diabetes mellitus, respiratory disease, other malignancies, and illicit drug use. Survival analyses revealed that increased comorbidity at diagnosis was significantly related to poorer overall survival (p=0.016), but not to cancer survival (p=0.369) or recurrence (p=0.652). Oropharyngeal cancer patients with HPV DNA positive tumors and lower levels of comorbidity had significantly better overall survival compared to patients with HPV negative tumors (hazard ratio = 0.2, 95%CI: 0.04–0.8), however there was no significant difference in overall (or disease specific) survival by HPV status among patients with higher levels of comorbidity at diagnosis (hazard ratio = 0.7, 95%CI: 0.2–2.8). Conclusion In an inner-city predominantly minority population, comorbidity at HNSCC diagnosis is relatively common and associated with poor overall survival, but not cancer survival or recurrence. Interestingly, the relationship between HPV and improved survival appears to be specific to patients with low comorbidity at diagnosis.

Association between comorbidity and survival in head and neck cancer: Results from Head and Neck 5000

“…In keeping with previous research, our baseline data also showed a lower burden of comorbidity and better unadjusted OS in people with HPV‐positive oropharyngeal cancers compared to HPV‐negative cases . In HPV‐stratified analyses, the dose–response relationship between comorbidity and survival was less pronounced.…”

“…In keeping with previous research, our baseline data also showed a lower burden of comorbidity and better unadjusted OS in people with HPV-positive oropharyngeal cancers compared to HPV-negative cases. 4,12,13,16,22,23,33 In HPV-stratified analyses, the dose-response relationship between comorbidity and survival was less pronounced. However, point estimates indicated that greater comorbidity remained associated with worse survival, independent of HPV status.…”

“…Our findings are consistent with previous studies that identified pretreatment comorbidity as an important independent prognosticator. [5][6][7]10,14,16,[22][23][24][25] Only a few of these previous studies were able to control for smoking and alcohol intake in their analyses 4,22,24,[26][27][28] and none adjusted for socioeconomic variables and health risk behaviors in the same model. Most of these studies only included people with oropharyngeal cancers.…”

HPV16 DNA status is a strong prognosticator of loco-regional control after postoperative radiochemotherapy of locally advanced oropharyngeal carcinoma: Results from a multicentre explorative study of the German Cancer Consortium Radiation Oncology Group (DKTK-ROG)

“…HPV-positive tumours most commonly originate from the oropharynx [12,13]; high-grade histology and positive lymph nodes are frequent [14]. Interestingly, a recent study observed that patients with HPV16 DNA positive oropharyngeal carcinoma and lower levels of comorbidity show a significantly better overall survival compared to patients with HPV16 DNA negative tumours [15]. Specifically for the field of Radiation Oncology, it has been shown that HPV-positivity is a strong prognostic marker for overall survival and/or local tumour control in patients treated with primary radiochemotherapy [16][17][18][19][20].…”

A head and neck cancer intervention for use in survivorship clinics: a protocol for a feasibility study

“…Primary care should include aggressive management of comorbid illnesses, risk modification (e.g., tobacco cessation), completion of recommended cancer screening for new (non-head and neck) cancers, vaccination, and receipt of general preventive care [21, 27]. Unfortunately, in two studies, between 18 and 50 % of head and neck cancer survivors reported ever seeing a primary care provider [28, 29].…”