Human papillomavirus and p16 immunostaining, prevalence and prognosis of squamous carcinoma of unknown primary in the head and neck region

Abstract

Science searches, observational studies and clinical trials that reported survival rates of patients with SCCUPHN by HPV status were identified. Meta-analysis estimated the prevalence and prognosis (overall survival, OS; progression-free survival, PFS) of SCCUPHN by HPV status, and compared them to studies of oropharyngeal squamous cell carcinoma (OPSCC) from the same institutions and across continents. In 17 SCCUPHN studies (n = 1,149) and 17 institution-matched OPSCC studies (n = 6,522), the pooled HPV prevalence of SCCUPHN was 49%, which was only 10% (95%CI: 1-19%) lower than OPSCC prevalence in the underlying population. Estimated 5-year OS for HPV-negative SCCUPHN was 44% (95%CI: 36-51%) vs. HPV-positive SCCUPHN of 91% (95%CI: 86-96%); hazard ratio (HR) for OS was 3.25 (95%CI: 2.45-4.31) and PFS was 4.49 (95%CI: 2.88-7.02). HRs by HPV status for OPSCC were similar to that in SCCUPHN. While North American SCCUPHNs had higher HPV prevalence than European SCCUPHNs (OR = 2.68 (95%CI: 1.3-5.6)), HR of OS for HPV-negative vs. HPV-positive patients were similar in both continents (HRs of 3.78-4.09). Prevalence of HPV among SCCUPHN patients were lower than in OPSCC. The survival benefit conferred by being HPV-positive was similar in SCCUPHN as in OPSCCs, independent of continent.

HPV driven squamous cell head and neck cancer of unknown primary is likely to be HPV driven squamous cell oropharyngeal cancer

“…The prevalence of CUP in our study was similar to that reported in other studies [10][11][12] as was the prevalence of CUP that were HPV driven. 14 Our observation that serology can identify HPV driven CUP confirms a previous report 15 and is unsurprising as they are likely to represent HPV driven OPC. Our observation that people with HPV driven CUP have improved survival is consistent with that reported in a recent meta-analysis.…”

“…9 A small proportion (<5%) of cancers in the head and neck present as a neck lump with no primary tumour apparent at initial presentation and are referred to as carcinoma of unknown primary (CUP). [10][11][12] A substantial proportion of people with CUP have HPV driven tumours 13,14 with an associated strong serological response 15 and better prognosis. [13][14][15][16][17] Furthermore, intensive investigation shows that CUP is often occult OPC.…”

“…[10][11][12] A substantial proportion of people with CUP have HPV driven tumours 13,14 with an associated strong serological response 15 and better prognosis. [13][14][15][16][17] Furthermore, intensive investigation shows that CUP is often occult OPC. 18,19 Some CUP arise in the nasopharynx and may be Epstein Barr virus (EBV) driven.…”

Review of emerging biomarkers in head and neck squamous cell carcinoma in the era of immunotherapy and targeted therapy

“…In most studies, baseline biomarkers are evaluated for their prognostic role for disease outcomes (regardless of treatment), reflected by critical clinical trial endpoints. Key endpoints include overall survival (OS), progression‐free survival (PFS), disease‐free survival (DFS), loco‐regional (LR) control, and distant metastasis‐free survival …”

Dental status of patients with squamous cell carcinoma of the oropharyngeal region

“…В Англии рак полости рта ежегодно увеличивался на 2,8% у мужчин и на 3,0% у женщин [3]. Рак орофарингеальной области является восьмой причиной смерти от рака во всем мире [4,5]. Для пациентов с карциномой орофарингеальной области ранней стадии характерна достаточно высокая пятилетняя выживаемость -82,4% [6].…”