Long‐term prognosis and risk factors among patients with HPV‐associated oropharyngeal squamous cell carcinoma

Abstract

Background A subset of HPV-associated oropharyngeal squamous cell carcinoma (HPV-OSCC) patients experience poor clinical outcomes. We explored prognostic risk factors on overall survival (OS) and recurrence free survival (RFS). Methods Patients with incident HPV-OSCC treated at the Johns Hopkins Hospital between 1997– 2008 with available tissue for HPV testing and demographic and clinicopathologic information (N=176) were included. Tissue was tested for HPV by in situ hybridization (ISH) and/or p16 immunohistochemistry (IHC). Demographic and clinicopathologic information was extracted from medical records. Results 90% (157/176) of the OSCC cases were HPV-associated. In the HPV-OSCC patients, we observed a 3- and 5-year OS rate of 93% (95% CI: 88%–98%) and 89% (95% CI: 81%–97%), respectively. Lower survival was observed with older patient age (HR 2.33 per 10-year increase, CI: 1.05–5.16, p=0.038), advanced clinical T-stage (HR 5.78, 95% CI: 1.60–20.8, p=0.007), and current tobacco use (HR 4.38, 95% CI: 1.07–18.0, p=0.04). Disease recurrence was associated with advanced clinical T stage (HR 8.32, 95% CI: 3.06–23, p<0.0001), current/former alcohol use (HR 13, 95% CI: 1.33–120, p=0.03), and unmarried status (HR 3.28, 95% CI: 1.20–9.00, p=0.02).. Patients who remained recurrence-free for 5 years had an 8.6% chance of recurrence by 10 years (one-sided 95% CI upper bound is 19%, p=0.088). Conclusions Prognostic risk factors are identified for HPV-OSCC patients. Observed recurrence rates between 5 and 10 years following definitive therapy needs to be validated in additional studies to determine whether extended cancer surveillance is warranted in this cancer population.

Systematic Review of Tobacco Use after Lung or Head/Neck Cancer Diagnosis: Results and Recommendations for Future Research

“…We identified 131 papers that reported the prevalence of tobacco use after lung or head/neck cancer diagnosis (4, 5, 9, 10, 28-154), with the earliest study published in 1980 (83). Most studies were conducted in the United States (60.3%, n =79; e.g., (74, 99, 101, 114, 134)), with the next most common study locations being in Canada (7.6%, n =10; (30, 38, 39, 44, 65, 84, 97, 104, 147, 148)) and France (4.6%, n =6; (32, 37, 100, 108, 113, 146)).…”

“…Given the clinical population, the predominance of older, male samples was not unexpected. Indeed, participants’ mean age at study enrollment was 61.8 ( SD =3.6; median=61.6) years (range: 55.0 (9) – 71.0 (67, 128)) and in 85.0% ( n =102/120) of papers, women made up fewer than half of the sample. Participants’ racial and ethnic background was infrequently reported (missing: 59.5%, n =78), as was their educational attainment (missing: 76.3%, n =100) and relationship status (missing: 71.0%, n =93).…”

“…Studies on the prevalence of persistent smoking after cancer diagnosis often yield highly divergent results. In head and neck (head/neck) cancer studies, for example, Lin and colleagues (9) found an 18% prevalence rate of current cigarette smoking while Duffy and colleagues (10) found a 30% prevalence rate. Reasons for such variation include heterogeneity in study design, outcome measurement, and sample characteristics.…”

Trends in epidemiology and treatment and outcome for head and neck cancer: A population-based long-term analysis from 1996 to 2011 of the Thuringian cancer registry

“…Most important, significant improvement in overall survival, most notably in those patients with HPV-related HNC, i.e. mainly oropharyngeal cancer, has been observed particularly over the past decade [8]. In contrast, the number of elderly people diagnosed with HNC is increasing [9].…”

Orbital Mass as First Presentation of Metastatic p16-Positive Oropharyngeal Squamous Cell Carcinoma

“…Currently, more than 80% of opscc diagnoses are hpv-related. Clinically, the relationship is commonly identified by an immunohistochemical analysis of biopsied tumour tissue for p16 expression, with positivity serving as a surrogate marker for hpv infection 3,4 . Evidence to date suggests that hpv status is a strong and independent biomarker for prognosis 5 .…”