The Incidence, Survival, and HPV Impact of Second Primary Cancer following Primary Oropharyngeal Squamous Cell Carcinoma: A 20-Year Retrospective and Population-Based Study

Abstract

Second primary cancer (SPC) is the second most common cause of death among patients diagnosed with head and neck cancer. This study examined the risk of SPC following oropharyngeal squamous cell carcinoma (OPSCC) and the impact of human papillomavirus (HPV) on survival following SPC. The study was a population-based, retrospective study including all patients diagnosed with OPSCC in eastern Denmark from 2000–2020 who received curative intended treatment. The incidence rate ratio (IRR), age-adjusted incidence rates (AAIR), and hazard ratios (HR) were calculated. A total of 2584 patients with primary OPSCC were included (median follow-up time: 3.1 years), with 317 patients (12.3%) diagnosed with SPC. The risk of SPC was approximately five times the occurrence of cancer in the general population (IRR: 4.96). The median time to SPC after a primary OPSCC was 2.0 years (interquartile range (IQR) = 0.6–4.2 years). HPV-positive (HPV+) patients had a significantly longer median time to SPC, and a significant better survival compared to HPV-negative (HPV-) patients. SPC was most frequently found in lungs, head, and neck (LHN) for HPV- OPSCC patients and lungs followed by gender-specific (prostate, ovaries, or endometrium) for HPV+ OPSCC. There was a significant difference between the two groups when distributed between “within” or “outside” LHN. Patients with SPC outside LHN had a significant better overall survival. This knowledge should be considered during post-treatment surveillance and might guide targeted imaging.

Oral Complications from Oropharyngeal Cancer Therapy

“…If adjuvant radiation with or without chemotherapy was delivered, the risk of SPMN decreased by 75%, with no associated changes in overall disease-free survival or overall survival [ 95 ]. HPV+ OPSCC patients had a decline in second primary malignancies and a significantly longer median time to development of SPMN [ 96 ]. Additionally, while 50% and 75% of local recurrence and distant metastasis occur within the first 200 and 400 days, respectively, the mean time for second primary cancers was 1589 days [ 97 ].…”

Special Issue “HPV in the Head and Neck Region 2.0”

“…Recently, we presented a Special Issue on “HPV in the head and neck region” which included several contributions to the overall knowledge of HPV in the head and neck region. In this second “Special Issue on HPV in the head and neck region 2.0”, eight original articles, one review, and one systematic review are presented [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

“…Three of the original articles describe the prevalence of HPV in locations and various consequences [ 3 , 4 , 5 ]. One article described the presence of HPV16L1 and HPV16E7 antibodies in the saliva and serum of 39 pregnant women and disclosed that 13 had persistent oral infection, but there was no correlation between a persistent infection and viral antibodies.…”

“…HPV16E6 and E7 transcripts were detectable in 92% and 79% of the HPV16-positive specimens, respectively, [ 4 ]. The third article focused on the risk of encountering a second primary cancer (SPC) after presenting an HPV-positive or HPV-negative oropharyngeal cancer (OPSCC) [ 5 ]. The authors followed up with 2584 patients diagnosed with OPSCC between 2000–2020, and during the follow-up period, 317 patients were diagnosed with an SPC with a median time interval of 2 years.…”

“…The authors followed up with 2584 patients diagnosed with OPSCC between 2000–2020, and during the follow-up period, 317 patients were diagnosed with an SPC with a median time interval of 2 years. Patients with HPV+ OPSCC had a significantly longer time to SPC when compared to those with HPV− OPSCC and the former had a significantly better survival as compared to the latter group [ 5 ].…”