The Impact of Human Papillomavirus (HPV) Associated Oropharyngeal Squamous Cell Carcinoma (OPSCC) on Nutritional Outcomes

Abstract

Background: Patients undergoing (chemo) radiotherapy for oropharyngeal squamous cell carcinoma (OPSCC) are at high risk of malnutrition during and after treatment. Malnutrition can lead to poor tolerance to treatment, treatment interruptions, poor quality of life (QOL) and potentially reduced survival rate. Human papillomavirus (HPV) is now known as the major cause of OPSCC. However, research regarding its effect on nutritional outcomes is limited. The aim of this study was to examine the relationship between HPV status and nutritional outcomes, including malnutrition and weight loss during and after patients’ (chemo) radiotherapy treatment for OPSCC. Methods: This was a longitudinal cohort study comparing the nutritional outcomes of HPV-positive and negative OPSCC patients undergoing (chemo) radiotherapy. The primary outcome was nutritional status as measured using the Patient Generated-Subjective Global Assessment (PG-SGA). Secondary outcomes included loss of weight, depression, QOL and adverse events. Results: Although HPV-positive were less likely to be malnourished according to PG-SGA at the beginning of treatment, we found that the difference between malnutrition rates in response to treatment was not significantly different over the course of radiotherapy and 3 months post treatment. HPV-positive participants had significantly higher odds of experiencing >10% weight loss at three months post-treatment than HPV-negative participants (OR = 49.68, 95% CI (2.7, 912.86) p ≤ 0.01). Conclusions: The nutritional status of HPV positive and negative patients were both negatively affected by treatment and require similarly intense nutritional intervention. In acute recovery, HPV positive patients may require more intense intervention. At 3- months post treatment, both groups still showed nutritional symptoms that require nutritional intervention so ongoing nutritional support is essential.

The changing face of head and neck cancer: are patients with human papillomavirus-positive disease at greater nutritional risk? A systematic review

“…A total of 4220 studies were identified during the search, with a final six publications [ 19 , 23 , 36 – 40 ] (total pooled OPC n = 635; pooled OPC+ n = 485) meeting full inclusion criteria (Fig. 1 ) with results summarised in Table 1 .…”

“…1 ) with results summarised in Table 1 . All were observational retrospective cohort studies [ 19 , 23 , 36 , 38 – 40 ]. Three were conducted in the USA [ 23 , 36 , 39 ], one in Canada [ 38 ], and two in Australia [ 19 , 40 ].…”

“…All were observational retrospective cohort studies [ 19 , 23 , 36 , 38 – 40 ]. Three were conducted in the USA [ 23 , 36 , 39 ], one in Canada [ 38 ], and two in Australia [ 19 , 40 ]. Only one study from Australia [ 19 ] reported mean BMI of participants at baseline ( n = 83; OPC+ 29.7 kg/m 2 (SD ± 6.2) versus OPC− 24.5 kg/m 2 (SD ± 5.3) ( p < 0.01)).…”

“…The American Joint Committee on Cancer (AJCC) eighth-edition Tumour-Node-Metastasis (TNM) classification system now distinguishes between these two histopathological sub-types, and recommends separate staging models [ 16 ]. Patients with OPC+ are often younger, non-smokers, more likely to be overweight and/or obese, and are less likely to present with pre-treatment weight loss due to the absence of tumour-related dysphagia or odynophagia limiting oral intake [ 17 – 19 ]. Patients with OPC+ have a better prognosis with improved response to treatment and favourable survival outcomes compared to those with OPC− , despite a trend for higher grade and more advanced nodal disease [ 20 – 22 ].…”

Comparison of Selected Immune and Hematological Parameters and Their Impact on Survival in Patients with HPV-Related and HPV-Unrelated Oropharyngeal Cancer

“…Moreover, the HPV+ OPC is more responsive to radiotherapy (RT) and chemoradiotherapy (CRT) [4,5,45]. It allows for treatment de-escalation in HPV+ patients [45][46][47]. In our opinion, this strong impact of HPV status on survival is associated with the presence of different prognostic factors in HPV− and HPV patients.…”