TY - JOUR
T1 - Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma Survival
T2 - A Comparison by Tumor Site and Initial Treatment
AU - Salazar, Christian R.
AU - Smith, Richard V.
AU - Garg, Madhur K.
AU - Haigentz, Missak
AU - Schiff, Bradley A.
AU - Kawachi, Nicole
AU - Anayannis, Nicole
AU - Belbin, Thomas J.
AU - Prystowsky, Michael B.
AU - Burk, Robert D.
AU - Schlecht, Nicolas F.
N1 - Funding Information:
Acknowledgments We thank the participants of this study; Margaret Brandwein-Gensler for her help with pathological staging and processing of tissue specimens; Catherine Sarta for her time and effort spent enrolling participants and with data entry; Gregory Rosenblatt for his assistance with data management; and Leslie Adrien for her help preparing and handling the biospecimens for molecular analysis. This work is supported in part by the National Cancer Institute [grant number CA115243]; National Institute of Dental and Craniofacial Research [T32 training grant DE007255]; the Einstein Cancer Research Center (P30 grant CA013330); and the Departments of Otorhinolaryngology-Head and Neck Surgery and Pathology at Albert Einstein College of Medicine and Montefiore Medical Center.
PY - 2014/3
Y1 - 2014/3
N2 - Recent evidence suggests that human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) patients have better survival than HPV-negative patients. However, it is unclear if similar patterns for survival exist across different tumor sites, and whether HPV-associated prognosis is modified by type of treatment. We prospectively tested 222 histologically confirmed HNSCC primary tumors for HPV DNA by PCR and HPV E6/E7 RNA by RT-PCR prior to treatment at a large urban health center. Cox proportional hazard ratio models were constructed to assess HPV-associated differences in overall and disease-specific survival adjusting for clinical and demographic covariates. HPV detection varied significantly by primary HNSCC tumor site, from 35 % for oropharynx, to 25 % for hypopharynx, 5 % for larynx, and 3 % for oral cavity (p < 0.0001), with HPV16 accounting for the majority (95 %) of HPV-positive tumors. The hazard-risk of overall and disease-specific death comparing HPV16-positive versus negative oropharyngeal HNSCC was reduced by 74 and 89 %, respectively (p values < 0.05), and was independent of other prognostic indicators; no statistically significant changes in outcomes were observed for non-oropharyngeal HNSCC sites. Prediction of overall survival was better with combined DNA and RNA HPV16 positive PCR detection. There was no difference in HPV16-associated survival whether patients received either surgery or (chemo)radiotherapy as their initial treatment modality. Improved HPV-associated HNSCC survival is limited to patients with oropharyngeal primaries. No selective treatment advantage is observed for HPV-positive tumors, although clinical trials are needed to evaluate which treatment modalities provide the most benefit for HPV-positive HNSCC.
AB - Recent evidence suggests that human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) patients have better survival than HPV-negative patients. However, it is unclear if similar patterns for survival exist across different tumor sites, and whether HPV-associated prognosis is modified by type of treatment. We prospectively tested 222 histologically confirmed HNSCC primary tumors for HPV DNA by PCR and HPV E6/E7 RNA by RT-PCR prior to treatment at a large urban health center. Cox proportional hazard ratio models were constructed to assess HPV-associated differences in overall and disease-specific survival adjusting for clinical and demographic covariates. HPV detection varied significantly by primary HNSCC tumor site, from 35 % for oropharynx, to 25 % for hypopharynx, 5 % for larynx, and 3 % for oral cavity (p < 0.0001), with HPV16 accounting for the majority (95 %) of HPV-positive tumors. The hazard-risk of overall and disease-specific death comparing HPV16-positive versus negative oropharyngeal HNSCC was reduced by 74 and 89 %, respectively (p values < 0.05), and was independent of other prognostic indicators; no statistically significant changes in outcomes were observed for non-oropharyngeal HNSCC sites. Prediction of overall survival was better with combined DNA and RNA HPV16 positive PCR detection. There was no difference in HPV16-associated survival whether patients received either surgery or (chemo)radiotherapy as their initial treatment modality. Improved HPV-associated HNSCC survival is limited to patients with oropharyngeal primaries. No selective treatment advantage is observed for HPV-positive tumors, although clinical trials are needed to evaluate which treatment modalities provide the most benefit for HPV-positive HNSCC.
KW - Chemotherapy
KW - Head and neck neoplasms
KW - Human papillomavirus
KW - Radiotherapy
KW - Surgery
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U2 - 10.1007/s12105-013-0486-4
DO - 10.1007/s12105-013-0486-4
M3 - Article
C2 - 24002971
AN - SCOPUS:84897621681
SN - 1936-055X
VL - 8
SP - 77
EP - 87
JO - Head and Neck Pathology
JF - Head and Neck Pathology
IS - 1
ER -