Human papillomavirus predicts outcome in oropharyngeal cancer in patients treated primarily with surgery or radiation therapy

Abstract

Objective:This study examines the prognostic significance of human papillomavirus (HPV) in patients with locally advanced oropharyngeal squamous cell carcinoma (SCC) treated primarily with surgery or definitive radiotherapy.Methods:One hundred and ninety-eight patients with Stage 3/4 SCC were followed up for recurrence in any form or death from any cause for between 1 and 235 months after diagnosis. HPV status was determined using HPV E6-targeted multiplex real-time PCR/p16 immunohistochemistry. Determinants of recurrence and mortality hazards were modelled using Cox's regression with censoring at follow-up dates.Results:Forty-two per cent of cancers were HPV-positive (87% type 16). HPV predicted loco-regional control, event-free survival and overall survival in multivariable analysis. Within the surgery with adjuvant radiotherapy (n=110), definitive radiotherapy-alone (n=24) and definitive radiotherapy with chemotherapy (n=47) groups, patients with HPV-positive cancers were one-third or less as likely to have loco-regional recurrence, an event or to die of any cause as those with HPV-negative cancers after adjusting for age, gender, tumour grade, AJCC stage and primary site. The 14 patients treated with surgery alone were considered too few for multivariable analysis.Conclusion:HPV status predicts better outcome in oropharyngeal cancer treated with surgery plus adjuvant radiotherapy as well as with definitive radiation therapy±chemotherapy.

Human Papillomavirus Infection and Prognostic Predictors in Patients with Oropharyngeal Squamous Cell Carcinoma

“…Some authors also found that patients with HPV-DNA positive tumors showed significantly improved prognosis regardless of the mode of treatment involving surgery with postoperative radiation or radiotherapy with or without chemotherapy (Licitra et al, 2006;Hong et al, 2010).…”

Partial p16 staining in oropharyngeal squamous cell carcinoma: extent and pattern correlate with human papillomavirus RNA status

“…The identification of HPV in patients' tumors correlates strongly with improved prognosis. 1,11,18,21,22 To clearly distinguish between tumors that are HPV-related and those that are not can be complicated, however. HPV-specific tests include DNA-based PCR, 21,23 DNA in-situ hybridization, 1,18 reverse-transcriptase PCR for E6 and E7 mRNA, 20,24 and more recently, RNA in-situ hybridization.…”

The Effect of Human Papillomavirus E6 Oncogene on the Radiosensitivity of Non-Oropharyngeal Cancer Cells

“…HPV is implicated in the majority (up to 70%) of OSCC in the western world and this subset of OSCC demonstrates favorable prognosis due to improved response to therapy, including radiation therapy (Gillison 2004, Gillison 2006, Weinberger, Yu et al 2006, Lassen, Eriksen et al 2009, Hong, Dobbins et al 2010. With increased knowledge of the role of HPV oncoproteins E6 and E7 in degrading tumour suppressor genes (p53 and pRb), there has been interest in recent years in exploring the pathways by which response to radiation are modulated.…”