Prognostic significance of human papillomavirus status and treatment modality in hypopharyngeal cancer

Abstract

Background Management of hypopharynx cancer is often extrapolated from larynx cancer. This report analyses treatment patterns and survival limited to hypopharynx cancer using the National Cancer Database (NCDB). Methods There are 9314 patients diagnosed with hypopharynx cancer between 2004 and 2016. The association between treatment modality and survival was analyzed using Kaplan–Meier survival curves and multivariable Cox regression. Results Five‐year overall survival ranged from 45% for stage I to 21% for stage IVB. Treatment modality did not influence survival in stage I/II. For stage III/IV, chemoradiation and surgery + adjuvant therapy were equivalent. Surgery yielded improved survival for T4 disease. Human papillomavirus (HPV)‐positive tumors were present in 21% and were associated with improved hazard ratio of death (0.60, p = <0.0001). Conclusions Survival is superior for T4 hypopharynx cancer managed with surgery, while treatment modality does not impact outcomes for other T‐stages. HPV‐positive tumors are associated with improved survival regardless of treatment.

Hypopharyngeal carcinoma in Finland from 2005 to 2014: outcome remains poor after major changes in treatment

“…Like in our 1990s series, and in the study by Burbure et al [ 5 ], RT alone was associated with worse survival compared with CRT and primary surgical treatment. Conclusions from this, however, can only be made with extreme caution, because in a retrospective study setting, the selection of patients in different treatment groups is highly biased.…”

“…Not only is the cancer itself difficult to cure because of typically late diagnosis and frequent distant metastases, but also the HPC patients tend to be heavy users of alcohol and tobacco with significant comorbidities and often poor nutrition status. The reported survival figures for patients diagnosed with HPC have typically been between 13 and 38%, and with only modest improvement in recent years [1][2][3][4][5].…”

Prognostic significance of head and neck spindle cell carcinoma

“…1,[43][44][45] Of importance, HPV-positive SpCC is rare and HPV positivity confers an appreciable survival benefit in most HNSCC. [46][47][48][49][50][51][52] The higher incidence of HPV negativity in oropharyngeal SpCC than SCC, which our data reflect, is therefore implicated in oropharyngeal survival disparities. Our data further reflect that SpCC histology has prognostic significance in the oropharynx independent of HPV status.…”

“…As HPV‐positive SCC predicts a more favorable response to all treatment modalities and improved survival, recent trends in HPV positivity may partially account for the independent prognostic significance of SpCC histology in the oropharynx 1,43–45 . Of importance, HPV‐positive SpCC is rare and HPV positivity confers an appreciable survival benefit in most HNSCC 46–52 . The higher incidence of HPV negativity in oropharyngeal SpCC than SCC, which our data reflect, is therefore implicated in oropharyngeal survival disparities.…”

Circulating p16-Positive and p16-Negative Tumor Cells Serve as Independent Prognostic Indicators of Survival in Patients with Head and Neck Squamous Cell Carcinomas

“…Human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) has been widely investigated and thought of as a critical biomarker in HN-SCC [1,2]. HPV-positive HNSCC, especially with oropharyngeal-originated tumors [3,4], has a significantly better prognosis (50% reduction of death risk) compared with those without HPV infection [5,6]. Even though patients with HPV-associated HNSCC had a better prognosis, primary concurrent chemoradiotherapy (CCRT) remains one of the standards of care [7].…”