Effect of HPV Status on Survival of Oropharynx Cancer with Distant Metastasis

Abstract

Human papillomavirus (HPV)–positive oropharynx squamous cell carcinoma (OPSCC) is known to have improved survival over HPV-negative disease. However, it is largely unknown whether HPV status similarly affects survival in patients presenting with distant metastatic disease. We queried the National Cancer Database for OPSCC with distant metastasis. Kaplan-Meier curves and Cox proportional hazards regression models controlling for relevant demographics were used to evaluate overall survival. In total, 768 OPSCC cases were available for analysis with HPV and survival data: 50% of cases were HPV negative and 50% were HPV positive. The 1- and 2-year survival for HPV-negative disease was 49% and 27%, respectively, as compared with 67% and 42% in the HPV-positive cohort. HPV positivity was associated with improved median survival in treated and untreated patients. Age, comorbidities, and HPV status were predictive of improved survival on multivariate analysis. HPV-positive OPSCC has improved survival in the setting of distant metastatic presentation as compared with HPV-negative disease and shows greater responsiveness to treatment.

Characterizing distant metastases and survival in oropharyngeal squamous cell carcinoma

“…More aggressive treatment of distant disease with curative intent has been established in prior studies to confer a survival advantage 8,11 . In an analysis of the National Cancer Database (NCDB), Kaplon et al found that HPV‐positive OPSCC patients presenting with M1 disease had significantly better survival than HPV‐negative patients with M1 diasease 16 . In addition, patients presenting with M1 disease are likely to be chemo‐naïve, increasing the potential efficacy of initial treatment.…”

Diffusion-Weighted Imaging to Assess HPV-Positive versus HPV-Negative Oropharyngeal Squamous Cell Carcinoma: The Importance of b-Values

“…1 The literature suggests that HPV-positive (HPV1) OPSCC is a distinct tumor entity with an improved response to radiation therapy and a better outcome in comparison with HPV-negative (HPV-) OPSCC. 2,3 As a result, the latest editions of the American Joint Committee on Cancer (AJCC) and the TNM Classification of Malignant Tumors staging manuals use different OPSCC staging criteria depending on HPV status. 4,5 The HPV status is established by p16 immunohistochemistry complemented by polymerase chain reaction to detect HPV DNA or by in situ hybridization for virus DNA and oncoprotein E6/E7 messenger RNA.…”

Distinct Outcomes of Oropharyngeal Squamous Cell Carcinoma Patients after Distant Failure According to p16 Status: Implication in Therapeutic Options

“…Distant metastases generally occur significantly later (beyond two years) and with a disseminating phenotype (more than two organs) in a non-negligible proportion of patients [18]. HPVpositive OPSCC has improved survival in the setting of distant metastatic presentation as compared with HPV-negative disease and shows greater responsiveness to treatment [19]. Oligometastatic status has been previously reported to be associated with improved survival in this population [20].…”