Novel nomograms for survival and progression in HPV+ and HPV- oropharyngeal cancer: a population-based study of 1,542 consecutive patients

Abstract

BackgroundNo study has combined tumour and clinical covariates for survival to construct an individual risk-profile for overall survival (OS), time to progression (TTP), and survival after progression (SAP) in patients with HPV+ and HPV– oropharyngeal squamous cell carcinoma (OPSCC). Based on the largest-to-date, unselected, population-based cohort of patients diagnosed with OPSCC, we performed a comprehensive analysis of long-term OS, TTP, and SAP and constructed novel nomograms to evaluate patients' prognoses.ResultsAt a median follow-up of 4.0 years (range: 0.8–15.8 yrs.), 690 deaths were recorded. The 5-year OS, TTP, and SAP for the HPV+/p16+ subgroup were 77%, 82%, and 33, vs. 30%, 66%, and 6% for the HPV–/p16– group (P < 0.01). 376 patients failed to maintain disease control with a median TTP of 13 months in the HPV+/p16+ subgroup vs. 8.5 months in the HPV–/p16– subgroup (P < 0.05). HPV combined with p16 status remained one of the most informative covariates in the final Cox regression model for OS, TTP, and SAP.MethodsWe included all patients diagnosed with OPSCC (n = 1,542) between 2000–2014 in Eastern Denmark. Survival rates were estimated by the Kaplan-Meier method. A multivariate Cox regression model was used to construct predictive, internally validated nomograms.ConclusionThe HPV+/p16+ subgroup had improved OS, TTP, and SAP compared with other combinations of HPV and p16 after adjusting for covariates. Nomograms were constructed for 1-, 5- and 10-year survival probability. Models may aid patients and clinicians in their clinical decision making as well as in counselling, research, and trial design.

Prevalence and Prognostic Significance of HPV in Laryngeal Squamous Cell Carcinoma in Northeast China

“…However, only a few studies have examined HPV-associated HNSCC in China [15]. Numerous studies have focused on HPV and p16 in OPSCC, while very few studies have addressed LSCC [16][17][18].…”

Systematic review on location and timing of distant progression in human papillomavirus‐positive and human papillomavirus‐negative oropharyngeal squamous cell carcinomas

“…[3][4][5][6][7] HPV-related OPSCC has a unique profile in terms of epidemiology, as well as clinical, molecular, and histopathological features compared to tobacco-and alcohol-associated OPSCC. [11][12][13] Distant progression (DP) in most cancers as well as in OPSCC is associated with severely poor outcomes, [14][15][16] and treatment is associated with considerably compromised quality of life. [11][12][13] Distant progression (DP) in most cancers as well as in OPSCC is associated with severely poor outcomes, [14][15][16] and treatment is associated with considerably compromised quality of life.…”

Individualized survival prediction for patients with oropharyngeal cancer in the human papillomavirus era

“…We identified four calculators: one developed at the MAASTRO Clinic (“MAASTRO”), 20 one based on data from Radiation Therapy Oncology Group (RTOG) trials (“RTOG”), 18 one based on patients treated in eastern Denmark (“Denmark”), 19 and one developed at Erasmus Medical Center (EMC) (“Erasmus”). 21, 23 Table 1 summarizes the data sources of each calculator, with additional details provided in Supplemental Tables 1–4.…”

“… * These represent uncorrected values; bias-corrected values are available in the corresponding published reports 18, 19 . OPSCC = oropharyngeal squamous cell carcinoma. C-index = concordance statistics.…”

“… * These represent uncorrected values; bias-corrected values are available in the corresponding published reports 18, 19 . …”