Survival outcomes by high‐risk human papillomavirus status in nonoropharyngeal head and neck squamous cell carcinomas: A propensity‐scored analysis of the National Cancer Data Base

Abstract

Background The prognostic relevance of human papillomavirus (HPV) status in patients with nonoropharyngeal (OPX) squamous cell cancer (SCC) of the head and neck is controversial. In the current study, the authors evaluated the impact of high‐risk HPV status on overall survival (OS) in patients with non‐OPX SCC using a large database approach. Methods The National Cancer Data Base was queried to identify patients diagnosed from 2004 through 2014 with SCC of the OPX, hypopharynx (HPX), larynx, and oral cavity (OC) with known HPV status. Survival was estimated using Kaplan‐Meier methods; distributions were compared using log‐rank tests. Propensity score–matching and inverse probability of treatment weighing (IPTW) methods were used; cohorts were matched based on age, sex, Charlson‐Deyo score, clinical American Joint Committee on Cancer (AJCC) group stage, treatments received, and anatomic subsite. Propensity analyses were stratified by group stage of disease. Results A total of 24,740 patients diagnosed from 2010 through 2013 were analyzed: 1085 patients with HPX, 4804 with laryngeal, 4,018 with OC, and 14,833 with OPX SCC. The percentages of HPV‐positive cases by disease site were 17.7% for HPX, 11% for larynx, 10.6% for OC, and 62.9% for OPX. HPV status was found to be prognostic in multiple unadjusted and propensity‐adjusted non‐OPX populations. HPV positivity was associated with superior OS in patients with HPX SCC with a hazard ratio (HR) of 0.61 (P < .001 by IPTW), in patients with AJCC stage III to IVB laryngeal SCC (HR, 0.79; P = .019 by IPTW), and in patients with AJCC stage III to IVB OC SCC (HR, 0.78; P = .03 by IPTW). Conclusions Positive high‐risk HPV status appears to be associated with longer OS in multiple populations of patients with non‐OPX head and neck disease (HPX, locally advanced larynx, and OC). If prospectively validated, these findings have implications for risk stratification.

Prognostic role of human papilloma virus status in hypopharyngeal squamous cell carcinoma

“…Chung et al 12 16,17,27 were combined with other subsites and/or were limited to patients with locally advanced disease, 28 or included patients with metastatic disease and those who did not receive appropriate therapies. 17 In comparison, our analysis of 18,19,[29][30][31] though most were limited by a small sample size…”

“…Proportions of HPV or p16 (a surrogate marker for HPV infection) positivity have been estimated at 13% to 24% in hypopharyngeal cancers, 9,[12][13][14] lower than those observed in nonoropharyngeal sites. Existing data regarding the prognostic value of HPV or p16 status 9,12,13,[15][16][17][18][19] in hypopharyngeal SCC is conflicting. A recent large study of US Veterans suggested that there may be a prognostic role for p16 status in nonoropharyngeal SCC, including patients with hypopharyngeal cancers, 13 although the sample size for that analysis was small.…”

Human papillomavirus and survival of patients with sinonasal squamous cell carcinoma

“…Previous studies have reported HPV testing rates of SCC to be as low as 10% to 11% in the NCDB for certain nonoropharyngeal head and neck subsites . Given the relatively small percentage of tumors that undergo testing, it is possible that the percentage of HPV‐positive SNSCCs could be influenced by testing biases.…”

“…Previous studies have reported HPV testing rates of SCC to be as low as 10% to 11% in the NCDB for certain nonoropharyngeal head and neck subsites. 23 Given the relatively small percentage of tumors that undergo testing, it is possible that the percentage of HPV-positive SNSCCs could be influenced by testing biases. If, for example, certain demographic or clinicopathologic factors (eg, a young patient with no smoking history) prompted a clinician to suspect and test a tumor for HPV, the previously reported rates of HPV-positive SNSCC could be elevated artificially.…”

Human Papillomavirus 16 and 18 Infection in Oral Cancer in Thailand: A Multicenter Study

“…Sexual behaviors such as oral sex practice and having multiple lifetime number of oral or genital sexual partners were associated with these cases (Emmett et al, 2018;Laprise et al, 2019). Regarding the prognosis, a significantly better survival and treatment response were observed among those with HPV infection (Li et al, 2018;Tian et al, 2019).…”