Increasing prevalence of human papillomavirus-positive oropharyngeal cancers among older adults

Melina J. Windon, Gypsyamber D'Souza, Eleni M. Rettig, William H. Westra, Annemieke van Zante, Steven J. Wang, William R. Ryan, Wojciech Mydlarz, Patrick K. Ha, Brett A. Miles, Wayne Martin Koch, Christine Gourin, David W Eisele, Carole Fakhry

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing among older adults. It is unknown whether these trends can be explained by human papillomavirus (HPV) and whether HPV-related tumors remain associated with an improved prognosis among older patients. METHODS: In a retrospective study of OPSCCs diagnosed from 1995 to 2013 at 2 National Comprehensive Cancer Network-designated cancer centers, p16 immunohistochemistry and in situ hybridization (ISH) for HPV-16, high-risk DNA, and/or E6/E7 RNA were performed. The median age at diagnosis was compared by p16 and ISH tumor status. Trends in age were analyzed with nonparametric trends. Survival was analyzed with the Kaplan-Meier method and Cox proportional hazards models. RESULTS: Among 239 patients, 144 (60%) were p16-positive. During 1998-2013, the median age increased among p16-positive patients (Ptrend = .01) but not among p16-negative patients (Ptrend = .71). The median age of p16-positive patients increased from 53 years (interquartile range [IQR] in 1995-2000, 45-65 years) to 58 years (IQR for 2001-2013, 53-64 years). Among patients ≥ 65 years old, the proportion of OPSCCs that were p16-positive increased from 41% during 1995-2000 to 75% during 2007-2013 (Ptrend = .04). Among all age groups, including older patients, a p16-positive tumor status conferred improved overall survival in comparison with a p16-negative status. CONCLUSIONS: The median age at diagnosis for HPV-related OPSCC is increasing as the proportion of OPSCCs caused by HPV rises among older adults. The favorable survival conferred by an HPV-positive tumor status persists in older adults.

Original languageEnglish (US)
JournalCancer
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Oropharyngeal Neoplasms
Neoplasms
In Situ Hybridization
Survival
Squamous Cell Carcinoma
Human papillomavirus 16
Proportional Hazards Models
Retrospective Studies
Age Groups
Immunohistochemistry
RNA
DNA
Incidence

Keywords

  • Elderly
  • Head and neck squamous cell carcinoma (HNSCC)
  • Human papillomavirus (HPV)
  • In situ hybridization (ISH)
  • Oropharyngeal squamous cell carcinoma (OPSCC)
  • P16

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Increasing prevalence of human papillomavirus-positive oropharyngeal cancers among older adults. / Windon, Melina J.; D'Souza, Gypsyamber; Rettig, Eleni M.; Westra, William H.; van Zante, Annemieke; Wang, Steven J.; Ryan, William R.; Mydlarz, Wojciech; Ha, Patrick K.; Miles, Brett A.; Koch, Wayne Martin; Gourin, Christine; Eisele, David W; Fakhry, Carole.

In: Cancer, 01.01.2018.

Research output: Contribution to journalArticle

Windon, Melina J. ; D'Souza, Gypsyamber ; Rettig, Eleni M. ; Westra, William H. ; van Zante, Annemieke ; Wang, Steven J. ; Ryan, William R. ; Mydlarz, Wojciech ; Ha, Patrick K. ; Miles, Brett A. ; Koch, Wayne Martin ; Gourin, Christine ; Eisele, David W ; Fakhry, Carole. / Increasing prevalence of human papillomavirus-positive oropharyngeal cancers among older adults. In: Cancer. 2018.
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abstract = "BACKGROUND: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing among older adults. It is unknown whether these trends can be explained by human papillomavirus (HPV) and whether HPV-related tumors remain associated with an improved prognosis among older patients. METHODS: In a retrospective study of OPSCCs diagnosed from 1995 to 2013 at 2 National Comprehensive Cancer Network-designated cancer centers, p16 immunohistochemistry and in situ hybridization (ISH) for HPV-16, high-risk DNA, and/or E6/E7 RNA were performed. The median age at diagnosis was compared by p16 and ISH tumor status. Trends in age were analyzed with nonparametric trends. Survival was analyzed with the Kaplan-Meier method and Cox proportional hazards models. RESULTS: Among 239 patients, 144 (60{\%}) were p16-positive. During 1998-2013, the median age increased among p16-positive patients (Ptrend = .01) but not among p16-negative patients (Ptrend = .71). The median age of p16-positive patients increased from 53 years (interquartile range [IQR] in 1995-2000, 45-65 years) to 58 years (IQR for 2001-2013, 53-64 years). Among patients ≥ 65 years old, the proportion of OPSCCs that were p16-positive increased from 41{\%} during 1995-2000 to 75{\%} during 2007-2013 (Ptrend = .04). Among all age groups, including older patients, a p16-positive tumor status conferred improved overall survival in comparison with a p16-negative status. CONCLUSIONS: The median age at diagnosis for HPV-related OPSCC is increasing as the proportion of OPSCCs caused by HPV rises among older adults. The favorable survival conferred by an HPV-positive tumor status persists in older adults.",
keywords = "Elderly, Head and neck squamous cell carcinoma (HNSCC), Human papillomavirus (HPV), In situ hybridization (ISH), Oropharyngeal squamous cell carcinoma (OPSCC), P16",
author = "Windon, {Melina J.} and Gypsyamber D'Souza and Rettig, {Eleni M.} and Westra, {William H.} and {van Zante}, Annemieke and Wang, {Steven J.} and Ryan, {William R.} and Wojciech Mydlarz and Ha, {Patrick K.} and Miles, {Brett A.} and Koch, {Wayne Martin} and Christine Gourin and Eisele, {David W} and Carole Fakhry",
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T1 - Increasing prevalence of human papillomavirus-positive oropharyngeal cancers among older adults

AU - Windon, Melina J.

AU - D'Souza, Gypsyamber

AU - Rettig, Eleni M.

AU - Westra, William H.

AU - van Zante, Annemieke

AU - Wang, Steven J.

AU - Ryan, William R.

AU - Mydlarz, Wojciech

AU - Ha, Patrick K.

AU - Miles, Brett A.

AU - Koch, Wayne Martin

AU - Gourin, Christine

AU - Eisele, David W

AU - Fakhry, Carole

PY - 2018/1/1

Y1 - 2018/1/1

N2 - BACKGROUND: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing among older adults. It is unknown whether these trends can be explained by human papillomavirus (HPV) and whether HPV-related tumors remain associated with an improved prognosis among older patients. METHODS: In a retrospective study of OPSCCs diagnosed from 1995 to 2013 at 2 National Comprehensive Cancer Network-designated cancer centers, p16 immunohistochemistry and in situ hybridization (ISH) for HPV-16, high-risk DNA, and/or E6/E7 RNA were performed. The median age at diagnosis was compared by p16 and ISH tumor status. Trends in age were analyzed with nonparametric trends. Survival was analyzed with the Kaplan-Meier method and Cox proportional hazards models. RESULTS: Among 239 patients, 144 (60%) were p16-positive. During 1998-2013, the median age increased among p16-positive patients (Ptrend = .01) but not among p16-negative patients (Ptrend = .71). The median age of p16-positive patients increased from 53 years (interquartile range [IQR] in 1995-2000, 45-65 years) to 58 years (IQR for 2001-2013, 53-64 years). Among patients ≥ 65 years old, the proportion of OPSCCs that were p16-positive increased from 41% during 1995-2000 to 75% during 2007-2013 (Ptrend = .04). Among all age groups, including older patients, a p16-positive tumor status conferred improved overall survival in comparison with a p16-negative status. CONCLUSIONS: The median age at diagnosis for HPV-related OPSCC is increasing as the proportion of OPSCCs caused by HPV rises among older adults. The favorable survival conferred by an HPV-positive tumor status persists in older adults.

AB - BACKGROUND: The incidence of oropharyngeal squamous cell carcinoma (OPSCC) is increasing among older adults. It is unknown whether these trends can be explained by human papillomavirus (HPV) and whether HPV-related tumors remain associated with an improved prognosis among older patients. METHODS: In a retrospective study of OPSCCs diagnosed from 1995 to 2013 at 2 National Comprehensive Cancer Network-designated cancer centers, p16 immunohistochemistry and in situ hybridization (ISH) for HPV-16, high-risk DNA, and/or E6/E7 RNA were performed. The median age at diagnosis was compared by p16 and ISH tumor status. Trends in age were analyzed with nonparametric trends. Survival was analyzed with the Kaplan-Meier method and Cox proportional hazards models. RESULTS: Among 239 patients, 144 (60%) were p16-positive. During 1998-2013, the median age increased among p16-positive patients (Ptrend = .01) but not among p16-negative patients (Ptrend = .71). The median age of p16-positive patients increased from 53 years (interquartile range [IQR] in 1995-2000, 45-65 years) to 58 years (IQR for 2001-2013, 53-64 years). Among patients ≥ 65 years old, the proportion of OPSCCs that were p16-positive increased from 41% during 1995-2000 to 75% during 2007-2013 (Ptrend = .04). Among all age groups, including older patients, a p16-positive tumor status conferred improved overall survival in comparison with a p16-negative status. CONCLUSIONS: The median age at diagnosis for HPV-related OPSCC is increasing as the proportion of OPSCCs caused by HPV rises among older adults. The favorable survival conferred by an HPV-positive tumor status persists in older adults.

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KW - Head and neck squamous cell carcinoma (HNSCC)

KW - Human papillomavirus (HPV)

KW - In situ hybridization (ISH)

KW - Oropharyngeal squamous cell carcinoma (OPSCC)

KW - P16

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