Patterns of disease events and causes of death in patients with HPV-positive versus HPV-negative oropharyngeal carcinoma

Abstract

Background and purpose: There have been no studies to date of patterns of events after oropharyngeal squamous cell carcinoma (OPC) treatment comprising disease progression immediately after treatment or after a disease-free interval (DFI), and causes of death, according to HPV status. Materials and methods: Patients with a T1-4, N0-3, M0 OPC who completed treatment in a curative intent at our center between 2011 and 2020 were analyzed. A DFI was defined as the absence of the disease confirmed by both physical and radiological evaluation. Results: We analyzed 888 patients, of who 451 were p16-positive and 437 were p16-negative. The 5-year survival rates were 82.4% vs. 44%, respectively (p < 0.0001, HR 0.24). The rates of disease progression at the end of the treatment without a DFI were 7.8% vs. 21.1% in the p16-positive vs. the p16-negative patients (p < 0.0001, OR 0.38). The 5-year competing risks of disease recurrence after a DFI were 5.6% vs. 20.5%, respectively (p < 0.0001, HR 0.26). Patients who were p16-positive had a lower risk of death from OPC disease (p < 0.0001, HR 0.23). The 5-year competing risks of a second primary cancer during follow-up were 16.1% vs. 49.9% (p = 0.0002) in the p16-positive vs. the p16-negative patients. Patients who were p16-positive had a lower risk of death from intercurrent causes (p < 0.0001, HR 0.17). Conclusion: Clinical trials and medical interventions dedicated to each category of events and causes of death are needed to improve survival in HPV-positive and HPV-negative OPC patients.

2011–2021 rising prevalence of HPV infection among oropharyngeal carcinoma in France

“…The increasing number of elderly patients with HPV-positive OPC has questioned treatment optimization of locally-advanced stage disease in patients who are not candidates for cisplatin [ 14 ]. The lower risk of disease progression and recurrences and the lower risk of death from any cause in HPV-positive OPC may change follow-up guidelines [ 15 ]. Finally, the increasing prevalence of HPV infection among patients with oropharyngeal cancer may warrant intensification of national prophylactic vaccination campaigns against HPV, which was extended to include boys in France in 2021 but still struggles to reach satisfactory rates [ 16 ].…”

Diagnostic Delay in HPV-Related Oropharyngeal Squamous Cell Carcinoma

“…16 HPVþ OPSCC is characterized by a younger patient population and association with nonsmoking status, 17,18 a propensity to cause malignancy in oropharyngeal sites compared with other sites of the head and neck, 19,20 smaller primary tumor size, 21 cystic lymph node metastasis, 22 improved response to radiotherapy, 23,24 improved survival compared with HPV-OPSCC, 17,25 and decreased risk of second primary malignancy. 26,27 Delays in diagnosis in HPV-related OPSCC is likely multifactorial. First, the presenting demographics, tumor characteristics, and symptoms of HPVþ OPSCC are distinct from "classic" HPV-disease.…”

Risk Stratification for Oropharyngeal Squamous Cell Carcinoma Using Texture Analysis on CT – A Step Beyond HPV Status

“…26 Hazard Ratio (HR)] and death (.24 HR) among these patients. 8 Therefore, identification of additional parameters in addition to HPV status to predict treatment response in OPSCC patients would be beneficial for personalization of care and selection of candidates for potential de-intensification treatment.…”

“…4-7 Despite the overall more favorable outcome for the HPV-positive OPSCC patient population, there is heterogeneity in the treatment response with a substantial risk of disease recurrence [.26 Hazard Ratio (HR)] and death (.24 HR) among these patients. 8 Therefore, identification of additional parameters in addition to HPV status to predict treatment response in OPSCC patients would be beneficial for personalization of care and selection of candidates for potential de-intensification treatment.…”