Competing mortality in oropharyngeal carcinoma according to human papillomavirus status

Abstract

Background The objective of the present study is to assess differences in the competing causes of death in patients with oropharyngeal carcinoma (OPC) as a function of the human papillomavirus (HPV) status. Methods We studied retrospectively 423 patients with OPC with known HPV status. Among the patients included in the study, 53 (12.5%) were HPV‐positive. We analyzed overall survival and competing causes of mortality according to the HPV status of the patients. Results Patients with HPV‐negative tumors had lower OPC cancer‐specific survival (P = .0001), second primary neoplasm survival (P = .0001), and noncancer‐related causes survival (P = .13) than patients with HPV‐positive tumors. This resulted in significant differences in overall survival depending on HPV status (P = .0001). Conclusion Conclusion: HPV‐positive OPC has a better overall survival than HPV‐negative OPC. Patients with HPV‐positive tumors presented a significant lower OPC cancer‐specific and second primary neoplasm mortality and a marginally nonsignificant lower noncancer mortality as compared to HPV‐negative tumors.

Durable therapeutic gain despite competing mortality in long-term follow-up of a randomized hyperfractionated radiotherapy trial for locally advanced head and neck cancer

“…It may be especially relevant to clinical trials, such as HPV-positive noninferiority deintensification trials which require long-term follow-up, since more than 50% of these patients remain smokers. A recent report suggests a higher non-cancer mortality in patients with HPV-positive tumours with smoking and alcohol use compared to those without such use [28]; these patients also have non-cancer related mortality causes similar to HPV-negative cases.…”

“…However, it is conceivable that the mortality profile of HPV-related LAHNSCC might be different from smoking-related LAHNSCC due to differences in risk factors and lifestyle. In fact, recent studies [28] shows that minimal smoking HPV + OPC had a lower competing mortality compared to those with a heavy smoking history. The latter also had non-cancer related mortality causes similar to HPV-negative cases [28].…”

“…In fact, recent studies [28] shows that minimal smoking HPV + OPC had a lower competing mortality compared to those with a heavy smoking history. The latter also had non-cancer related mortality causes similar to HPV-negative cases [28]. Therefore, we strongly advocate smoking cessation as a component of the holistic care of head and neck cancer patients to both minimize long term smoking related co-morbidity and mortality as well as to potentially reduce the impact of smoking during radiotherapy which has been prospectively demonstrated to meaningfully influence hypoxia and disease control [44,45].…”

“…Cure of head and neck cancer is challenged by susceptibility to competing mortality risk since long-term survivors remain vulnerable to smoking-related second primary malignancies and comorbidities, as well as treatment-related toxicities (e.g. aspiration pneumonia, carotid stenosis) [16,[25][26][27][28][34][35][36][37]. Toxicity related mortality is often difficult to differentiate from mortality related to smoking and challenging to capture and categorize reliably.…”

“…Compared to the CF arm, HF arm had a 10% 5-year improved OS [40% (33-47) vs 30% (23-37)], but the benefit diminished to 3% at 10-years [21% (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) vs 18% (12-24)] and 15-years [11% (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) vs 8% (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)] (p = 0.04). At last follow-up, 149 deaths had occurred in each arm, of which 105 HF and 115 CF deaths manifested within the initial 5 years.…”