Short‐term mortality risks among patients with oropharynx cancer by human papillomavirus status

Abstract

Background There is substantial variation in head and neck cancer (HNC) mortality and competing mortality among patients with HNC. In this study, the authors characterize the causes and risks of short‐term mortality among patients with oropharynx cancer (OPC) and how these risks differ by human papillomavirus (HPV) status. Methods A custom Surveillance, Epidemiology, and End Results (SEER) data set with HPV status was used to identify 4930 patients with OPC who were diagnosed with nonmetastatic (M0) disease from 2013 to 2014, including 3560 (72.2%) HPV‐positive patients and 1370 HPV‐negative patients. Causes of death and cumulative incidence estimates for HNC‐specific mortality, competing mortality, second‐cancer mortality, and noncancer mortality were analyzed by HPV status. Risk factors for mortality events were determined using multivariable competing risk regression models. Results Compared with HPV‐negative patients, HPV‐positive patients had a lower risk of 2‐year cumulative incidence of all‐cause mortality (10.4% vs 33.3%; P < .0001) and a lower risk of both HNC‐specific mortality (4.8% vs 16.2%; P < .0001) and competing‐cause mortality (5.6% vs 16.8%; P < .0001). Second‐cancer mortality was the most common cause of non‐HNC mortality among HPV‐negative patients. Both second‐cancer mortality and noncancer mortality were significantly higher among patients who had HPV‐negative OPC (10.8% and 6.1%, respectively) compared with those who had HPV‐positive OPC (2.4% and 3.2%, respectively; both P < .0001). The median follow‐up was 11 months (range 1‐23 months) in this cohort with known HPV‐status. Conclusions Patients with HPV‐positive and HPV‐negative OPC have significantly different rates of both HNC mortality and competing mortality. HPV‐negative patients are at substantial risk of competing mortality, even within 2 years of cancer diagnosis. These differences can inform power calculations for clinical trials and patient management in the acute and survivorship settings.

A prognostic long non-coding RNA-associated competing endogenous RNA network in head and neck squamous cell carcinoma

“…New studies have shown that patients with HPV-positive and HPV-negative oropharyngeal cancer have dramatically different rates of both head and neck carcinoma mortality and competing-cause mortality. Compared with HPV-positive patients, HPVnegative patients have a higher risk of two-year cumulative incidence of all-cause mortality and a lower risk of both head and neck carcinoma-specific mortality and competing-cause mortality (p < 0.0001) (Fullerton et al, 2020). Therefore, we believe that the HPV status is a critical determinant in oropharyngeal cancer.…”

“…Previous publications have focused in part on ceRNAs in laryngeal squamous cell carcinoma (LSCC) (Kong et al, 2019;Liu & Ye, 2019;Gao et al, 2019;Zhao et al, 2019;Sun et al, 2018;Feng et al, 2016), tongue squamous cell carcinoma (TSCC) (Sturgis & Cinciripini, 2007), and nasopharyngeal carcinoma (NPC) (Fullerton et al, 2020;Agrawal et al, 2011). These studies have identified differentially expressed RNAs by lncRNA and mRNA integrated microarrays of cancer tissue or by immunohistochemistry (Gao et al, 2019;Zhao et al, 2019;Sun et al, 2018;Feng et al, 2016).…”

The effect of human papillomavirus status on prognosis and local treatment strategies of T1-2N0 oropharyngeal squamous cell cancer

“…HPV status was tested using immunohistochemistry for p16 and/or polymerase chain reaction (PCR) or in situ hybridization (ISH)-based methods of pathologic specimens from either the primary oropharyngeal tumors or the corresponding cervical lymph node metastases. This HPV data set is reviewed by a SEER data-quality team to ensure accuracy ( 12 ). This study used a public de-identified SEER database and the institutional review board approval was waived.…”

Interventions for head and neck cancer survivors: Systematic review

“… 4 , 5 , 6 , 7 Both recurrence and subsequent malignancies are common, especially among HNC survivors with heavy alcohol and tobacco use. 8 Furthermore, HNC survivors may have pre‐existing comorbidities that require ongoing medical management and health promotion to reduce risk. With such complex ongoing health issues, HNC survivors require coordinated care beyond treatment completion.…”