The Rise of HPV-Positive Oropharyngeal Cancers in the United States

Fakhry, Carole; Cohen, Ezra E.W.

doi:10.1158/1940-6207.capr-14-0425

Cited by 20 publications

(22 citation statements)

References 29 publications

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“…There has been interest in better understanding racial differences in survival among cancer patients . Several prior analyses have identified differences in survival for OPSCC patients in white and black study populations.…”

Section: Discussionmentioning

confidence: 99%

The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancer

Fakhry

Westra

Wang

et al. 2017

Cancer

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203

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BACKGROUND Human papillomavirus (HPV) is a well-established prognostic marker for oropharyngeal squamous cell cancer (OPSCC). Because of the limited numbers of women and nonwhites in studies to date, sex and racial/ethnic differences in prognosis have not been well explored. In this study, survival differences were explored by the tumor HPV status among 1) patients with OPSCCs by sex and race and 2) patients with nonoropharyngeal (non-OP) head and neck squamous cell cancers (HNSCCs). METHODS This retrospective, multi-institution study included OPSCCs and non-OP HNSCCs of the oral cavity, larynx, and nasopharynx diagnosed from 1995 to 2012. Race/ethnicity was categorized as white non-Hispanic, black non-Hispanic, Asian non-Hispanic, and Hispanic of any race. Tumors were centrally tested for p16 overexpression and the presence of HPV by HPV16 DNA and high-risk HPV E6/E7 messenger RNA in situ hybridization. Kaplan-Meier and Cox proportional hazards models were used to evaluate overall survival (OS). RESULTS The study population included 239 patients with OPSCC and 621 patients with non-OP HNSCC with a median follow-up time of 3.5 years. After adjustments for the tumor HPV status, age, current tobacco use, and stage, the risk of death was lower for women versus men with OPSCC (adjusted hazard ratio, 0.55; P =.04). The results were similar with p16. In contrast, for non-OP HNSCCs, HPV positivity, p16 positivity, and sex were not associated with OS. CONCLUSIONS For OPSCC, there are differences in survival by sex, even after the tumor HPV status has been taken into account. For non-OP HNSCC, the HPV status and the p16 status are not of prognostic significance.

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Section: Discussionmentioning

confidence: 99%

The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancer

Fakhry

Westra

Wang

et al. 2017

Cancer

Self Cite

203

197

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“…7,9,10 Although in the past decade HPV-OPC has been described to be a disease of men and whites, 18 these data underscore the rapidly changing epidemiology of HPV-OPC. Although the prevalence of HPV-positive tumors remains highest among men and whites with OPC in 2015 (~75%), the majority of OPC cases among women, blacks, Hispanics, and Asians in the United States are now HPV-positive (range, 53.7%-68.8%).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] This rising incidence is attributed to oncogenic human papillomavirus (HPV). 7,9,10 Whether these trends apply more broadly in the United States is unknown. 7,9,10 Whether these trends apply more broadly in the United States is unknown.…”

Section: Introductionmentioning

confidence: 99%

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

Faraji

Rettig

Tsai

et al. 2018

Cancer

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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.

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“…These cancers are complex both in terms of their molecular characteristics and etiological risk factors. Existing literature shows that human papillomavirus (HPV) exposure is associated with an increased risk of HNC, but confers a better prognosis . Conversely, tobacco use and alcohol consumption are risk factors that lead to increased HNC incidence and worse survival .…”

Section: Introductionmentioning

confidence: 99%