The prevalence of human papillomavirus in oropharyngeal cancer is increasing regardless of sex or race, and the influence of sex and race on survival is modified by human papillomavirus tumor status

Abstract

BACKGROUND:The purpose of this study was to evaluate the influence of sex and race/ethnicity upon prevalence trends of human papillomavirus (HPV) in oropharyngeal cancer (OPC) and survival after OPC. METHOD: This was a cohort study of patients included in the United States National Cancer Database who had been diagnosed with OPC between 2010 and 2015. Outcomes were HPV status of tumor specimens and overall survival. Sex-and race-stratified trends in HPV prevalence were estimated using generalized linear modeling. The influence of sex, race, and HPV tumor status on overall survival was compared by Kaplan-Meier method and Cox Proportional Hazards models. RESULTS: This analysis included 20,886 HPV-positive and 10,364 HPV-negative OPC patients. The prevalence of HPV-positive tumors was higher among men (70.6%) than women (56.3%) and increased significantly over time at a rate of 3.5% and 3.2% per year among men and women, respectively. The prevalence of HPV-positive tumors was highest among whites (70.2%), followed by Hispanics (61.3%), Asians (55.8%), and blacks (46.3%). Blacks and Hispanics experienced significantly more rapid increases in prevalence of HPV-positive tumors over time compared with whites (6.5% vs 5.6% vs 3.2% per year, respectively). In HPV-positive OPC, neither sex nor race/ethnicity was associated with survival among patients with HPV-positive OPC. In contrast, for HPV-negative OPC, risk of death was significantly higher for women versus men (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.08-1.26) and blacks versus whites (aHR, 1.21; 95% CI, 1.10-1.33). CONCLUSION: The prevalence of HPVpositive tumors is increasing for all sex and race/ethnicity groups in the United States. Sex and race are independently associated with survival for HPV-negative but not HPV-positive OPC. Cancer 2019;125:761-769.

Tumor‐infiltrating lymphocyte quantification stratifies early‐stage human papillomavirus oropharynx cancer prognosis

“…4 Moreover, the design of this study pertaining to patient selection limits the generalizability of our findings specifically to surgically treated disease, which represents the treatment of 40% of patients with HPV-OPC. 55 Whether TIL density can reliably stratify risk based on biopsy specimens, as would be required for patients who plan to undergo primary radiotherapy, is unknown and represents a direction of future investigation. These results support the continued investigation of TIL density to stratify prognosis of HPV-OPC.…”

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

“…Extrapolation of recent national trends suggest that, in the coming years, older Caucasian men will make up the majority of new cases, whereas rates may plateau in younger Caucasian men [10,12]. Recent studies have also shown rates of HPV-positive OPSCC to be increasing in women as well as non-Caucasian individuals, demonstrating the widespread impact of HPV-positive OSPCC across all populations [13,14].…”

Computed tomography performance in predicting extranodal extension in HPV‐positive oropharynx cancer

“…Oropharyngeal carcinoma (OPC) is now the most common type of head and neck squamous cell carcinoma (HNSCC), and HPV is the primary cause of OPC in the United States . Furthermore, whereas human papillomavirus‐related oropharyngeal cancer (HPV‐OPC) was historically considered a disease of younger (age < 60 years) white men, recent studies show that HPV‐OPC is increasingly affecting broader demographics, including women, minorities, and older patients . These findings highlight the continually expanding societal impact of HPV‐OPC …”