HPV status and regional metastasis in the prognosis of oral and oropharyngeal cancer

Abstract

Prognostic factors are important for treatment decisions as they help adapt the therapy on a case-to-case basis. Nodal status, number of positive nodes, and presence of extracapsular spread are considered to be the important prognostic factors in head and neck cancer. Some studies suggest that human papillomavirus (HPV) status also influences the outcome of the treatment. This influence can be explained by the variation in tendency to develop regional metastases and by variation in the type of neck node involvement. The study objectives were to compare patients with HPV positive and HPV-negative tumors for survival and prevalence and type of regional metastasis, to identify prognostic factors and to test whether HPV presence is an independent factor of survival. The study included 81 patients treated by surgery including neck dissection for oral or oropharyngeal squamous cell cancer. A computerized medical report was completed for each patient. Analysis of the tumor specimen for the HPV DNA presence was done on paraffin-fixed tissue. HPV DNA detection and typing were performed by PCR with GP5+/GP6+BIO primers and reverse line blot hybridization. Overall, 64% (52/81) of tumors were HPV positive with 80% in the tonsillar site. HPV-positive patients had significantly better both overall (73 vs. 35%) (P=0.0112) and disease-specific (79 vs. 45%) (P=0.0015) survival rates than HPV-negative patients. No significant differences were found in the pN classification, in the number of positive nodes and the presence of extracapsular spread in the involved nodes between HPV positive and HPV-negative tumors. Multivariate analysis showed that significant prognostic factors of survival were the presence of HPV in the tumor, extracapsular spread and tumor size. HPV was the most significant prognostic factor in the studied group of patients with oropharyngeal tumors (HR=0.27, 95%CI 0.12-0.61) and possibly should be considered in treatment decisions.

Survey on human papillomavirus/p16 screening use in oropharyngeal carcinoma patients in the United States

“…Although the discovery of HPV in patients with OPSCC was reported first as early as 1990, 21 and its prognostic significance is well documented, [8][9][10][11] we observed that only 40.4% of radiation oncology practices (76 of 188 respondents) in our survey across the United States use screening for this prognostic marker. Academic practices screen twice as often as private practices.…”

“…[5][6][7] Patients with HPV-positive OPSCC reportedly have a better prognosis than patients with HPV-negative OPSCC. [8][9][10][11] In a prospective clinical trial by Fakhry et al, it was reported that patients who had HPV-positive OPSCC had a 95% overall survival rate at 2 years compared with a rate of 62% for patients who had HPV-negative disease. 8 Numerous retrospective studies also have demonstrated improved disease-free survival rates (range, 32%-38%) and overall survival rates (range, 24%-34%) in HPV-positive versus HPV-negative OPSCC, respectively.…”

“…8 Numerous retrospective studies also have demonstrated improved disease-free survival rates (range, 32%-38%) and overall survival rates (range, 24%-34%) in HPV-positive versus HPV-negative OPSCC, respectively. 9,10 This makes HPV status 1 of the most important biologic predictive factors in patients with head and neck cancer. To put this level of prognostic importance into perspective, a review of 5 prospective studies that enrolled patients with nonmetastatic breast cancer who had 5 years of follow-up (minimum 500 patients) revealed that the absolute overall 5-year survival improvement for estrogen receptor-positive patients versus estrogen receptor-negative patients was only 7% to 14%.…”

Human Papillomavirus and Related Diseases - From Bench to Bedside - A Clinical Perspective

“…HPV-infected HNSCCs have favorable prognoses upon treatment compared with HPV-negative tumors at a similar clinical stage (Leemans et al, 2011). Most investigations that have evaluated HPV infection and survival agree that HPV-positive patients have a significantly better survival (5-year survival of approximately 70%) than HPV-negative patients (5-year survival of approximately 35%) Klozar et al, 2008;Vidal & Gillison, 2008). A prospective multicentric study has shown that individuals presenting HPV-positive OPCs had better response rates to chemotherapy than individuals with no HPV infection .…”

The Role of Human Papillomavirus in Head and Neck Cancers

“…HPV-infected HNSCCs have favorable prognoses upon treatment compared with HPV-negative tumors at a similar clinical stage (Leemans et al, 2011). Most investigations that have evaluated HPV infection and survival agree that HPV-positive patients have a significantly better survival (5-year survival of approximately 70%) than HPV-negative patients (5-year survival of approximately 35%) (Fakhry et al, 2008;Klozar et al, 2008;Vidal & Gillison, 2008). A prospective multicentric study has shown that individuals presenting HPV-positive OPCs had better response rates to chemotherapy than individuals with no HPV infection (Fakhry et al, 2008).…”