Are there differing prognostic factors between human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC), and do sex and race play a part?
Women with HPV-positive OPSCC may have improved overall survival compared to men. Sex does not play a prognostic role in HPV-negative OPSCC, and there are no differences in prognosis by race among HPV-positive or HPV-negative patients.
Background: Between 1975 and 2012, OPSCC incidence increased 62.6% in the U.S., while oral cavity squamous cell cancer declined over the same period. This disparity can be attributed to the rise in HPV-positive OPSCC. HPV-positive and HPV-negative OPSCC are now considered distinct entities, but the clinical factors that influence overall survival for each remain unknown.
Study design: Retrospective case series of 239 incident OPSCC patients (134 HPV-positive, 105 HPV-negative) from 1995 to 2012.
Setting: Johns Hopkins Hospital, Baltimore; University of California, San Francisco, San Francisco.
Synopsis: There were no differences in age or sex between HPV-positive and HPV-negative OPSCC. HPV-negative patients were more likely to be black, former/current smokers, former/current drinkers, and have a higher American Joint Committee on Cancer (AJCC) overall stage. Women with OPSCC were more likely to be white, never-smokers, and never-drinkers. Black OPSCC patients were younger, had higher overall AJCC stage, and were more likely to smoke than patients of other races. HPV-positive patients had significantly longer follow-up than the median (3.5 years). HPV-positive OPSCC patients were less likely to die from any cause during follow-up. In univariate analysis, the strongest factors associated with overall survival among HPV-positive OPSCC patients were higher tumor, nodal, and overall AJCC stage.
After adjusting for stage, age, and tobacco use, risk of death remained lower in women than men. Of the HPV-positive OPSCCs, the majority were HPV-16 positive, with a proportion similar among men and women, but differing by race. There was no significant difference in overall survival between HPV-negative OPSCC men and women, or among all races. Risk factors for survival were similar when classifying tumors by tumor p16 status.
Limitations included the study’s retrospective nature and heterogeneous treatment histories.
Citation: Yin LX, D’Souza G, Westra WH, et al. Prognostic factors for human papillomavirus-positive and negative oropharyngeal carcinomas. Laryngoscope. 2018;128:E287–E295.