Human papillomavirus and p16 detection in cervical lymph node metastases from an unknown primary tumor

Validation of Human Papillomavirus as a Favourable Prognostic Marker and Analysis of CD8+ Tumour-infiltrating Lymphocytes and Other Biomarkers in Cancer of Unknown Primary in the Head and Neck Region

“…Recently, we and others have reported similarities in clinical behaviour between HPV-positive HNCUP and HPVpositive oropharyngeal SCC, with a significantly better clinical outcome for patients with HPV-positive HNCUP compared to those with HPV-negative HNCUP (11,(14)(15). However, other surveys have not found an impact of HPV status on survival, leaving the role of HPV in prognosis in HNCUP unresolved (16,17).…”

“…The definition of HNCUP and the scope of the diagnostic work-up before deciding on a HNCUP diagnosis may vary between studies and can affect the obtained data (15)(16)(17). In studies where bilateral tonsillectomy, a procedure often revealing the primary tumour, was part of the work-up, some reports show that HPV + HNCUP, defined by presence of HPV DNA or overexpression of p16, have better clinical outcome than HPV − HNCUP (14,15). Other studies have however not been able to demonstrate a survival difference in a similar HNCUP setting (16,17).…”

Human papillomavirus is a favourable prognostic factor in cancer of unknown primary in the head and neck region and in hypopharyngeal cancer

“…In 1.5-9% of the cases, however, a primary tumour may not be identified, despite a systematic clinical work-up including tonsillectomy, random biopsies from the base of the tongue and nasopharynx, and magnetic resonance imaging of the head and neck (17). In such cases, the lymph node metastasis is defined as CUP of the head and neck region (10)(11)(12)(13)(14)(15)(16)(17). FNAC showing a cancer other than SCC, e.g.…”

“…Accumulating reports describe the presence of HPV DNA in several cancers of unknown primary (CUP) in the head and neck region, as well as in a minority of hypopharyngeal cancers and other non-OPSCC locations (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). Notably, patients with HPV-positive tumours, particularly in CUP of the head and neck region and possibly also in hypopharyngeal cancer, tend to have a better clinical outcome compared with those with corresponding HPV-negative tumours, in whom HPV status may also have implications for diagnosis and therapy (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)27,28). However, this has not been investigated in the same detail for other cancer locations in the head and neck region, whereas reports usually compare survival between patients with HPV-positive and those with HPV-negative non-OPSCC.…”

Patterns of Failure in Patients With Head-and-Neck Carcinoma of Unknown Primary Treated With Radiation Therapy

“…Finally, similar to oropharyngeal cancers, recent data have implicated human-papillomavirus (HPV) association as a major prognostic factor for disease-free and overall survival in patients with HNCUP. [28][29][30][31] Irradiating the oropharynx alone may be sufficient for a patient with a HPV-associated cancer and no involved lymph nodes below level II. However, any suspicion of nasopharyngeal primary tumors warrants coverage of the nasopharynx, as recent data have associated HPV-positive nasopharyngeal carcinomas with a significantly worse prognosis compared with their HPV-negative counterparts.…”