Risk Factors for Overall Survival Outcome in Surgically Treated Human Papillomavirus-Negative and Positive Patients with Oropharyngeal Cancer

Abstract

Introduction: This study reports the oncological outcome of a non-selected series of patients with human papillomavirus(HPV)-positive and -negative oropharyngeal squamous cell carcinoma (OSCC) preferentially managed with upfront surgery. Methods: Consecutive OSCC cases (n = 378) diagnosed from 2000 to 2010 in our department were evaluated for risk factors, HPV association, therapy and overall survival (OS). HPV status was determined by combined DNA and p16 testing, and treatment was defined as the first course of treatment with any kind of surgery (upfront surgery) or primary chemoradiotherapy. OS of HPV-associated and HPV-negative patients was compared using Kaplan-Meier and multivariable Cox regression analyses. Results: The majority of OSCC patients (215 of 361; 69.5%) received upfront surgery as first-line treatment in curative intent. The 5-year OS rate in patients with HPV-positive and HPV-negative tumors were 81.1 and 39.7%, respectively. Upfront surgery in HPV-negative (p < 0.001) and HPV-positive patients (p = 0.05) resulted in improved OS only in advanced stages. Multivariate analysis for patients revealed age in HPV-associated OSCC as an independent predictor for improved survival, and age, performance, N status and therapy as independent predictors in HPV-negative OSCC. Conclusions: Non-selected OSCC patients amenable to curative therapy show poor 5-year OS. The benefit of upfront surgery remains unclear. A younger patient age was the main factor for a better outcome in patients with HPV-associated OSCC.

Increasing Incidence rates of Oropharyngeal Squamous Cell Carcinoma in Germany and Significance of Disease Burden Attributed to Human Papillomavirus

“…HPV-related OPSCC have been recently recognized as their own entity beside HPV-negative tumors with respective staging concepts introduced in 2018 (14). This issue has emerged because patients with HPV-associated OPSCC have a remarkably better prognosis (9,15), but the HPV status has had no impact on the treatment decision to date. Therefore, patients with HPV-associated OPSCC might be overtreated and treatment deescalation is under investigation in clinical trials.…”

Detection of human papillomavirus distinguishes second primary tumors from lung metastases in patients with squamous cell carcinoma of the cervix

“…The overexpression of p16 is strongly associated with the infection of high-risk human papilloma virus (hrHPV), and has been used as a surrogate marker for predicting the HPV status in the head and neck SqCCs 4,5 and SCCCs. 6 However, the correlation between p16 and HPV infection is not well established in primary lung SqCC.…”

Cytopathologic characteristics of HPV‐related small cell carcinoma of the oropharynx

“…Patients with HPV‐related SqCC are generally younger than patients with conventional SqCC, are more frequently nonsmokers, and often present with small palatine tonsil or base of tongue primaries and early neck lymph node metastases . Importantly, HPV‐related SqCC is associated with better overall survival with an improved response to chemotherapy and radiation treatment in comparison with conventional SqCC . As a result, HPV testing has become routine practice for oropharyngeal SqCC because it has significant implications for prognosis and clinical trial enrollment …”

“…1,3 Importantly, HPV-related SqCC is associated with better overall survival with an improved response to chemotherapy and radiation treatment in comparison with conventional SqCC. [4][5][6] As a result, HPV testing has become routine practice for oropharyngeal SqCC because it has significant implications for prognosis and clinical trial enrollment. 7,8 Several histologic variants of HPV-related oropharyngeal carcinoma, including basaloid, papillary, lymphoepithelial-like, adenosquamous, and sarcomatoid SqCC variants, have been identified.…”