Long-term prognosis and risk factors among patients with HPV-associated oropharyngeal squamous cell carcinoma

Brian M. Lin, Hao Wang, Gypsyamber D'Souza, Zhe Zhang, Carole Fakhry, Andrew W. Joseph, Virginia E. Drake, Giuseppe Sanguineti, William H. Westra, Sara I. Pai

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND A subset of patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV-OSCC) experience poor clinical outcomes. The authors of this report explored prognostic risk factors for overall survival (OS) and recurrence-free survival (RFS). METHODS Patients with incident HPV-OSCC who received treatment at the Johns Hopkins Hospital between 1997 and 2008 and who had tissue available for HPV testing as well as demographic and clinicopathologic information (N = 176) were included. Tissue was tested for HPV by in situ hybridization (ISH) and/or p16 immunohistochemistry. Demographic and clinicopathologic information was extracted from medical records. RESULTS In total, 157 of 176 patients (90%) with OSCC had HPV-associated disease (HPV-OSCC). In the patients with HPV-OSCC, the 3-year and 5-year OS rates were 93% (95% confidence interval [CI], 88%-98%) and 89% (95% CI, 81%-97%), respectively. Shorter survival was observed among older patients (hazard ratio [HR], 2.33 per 10-year increase; 95% CI, 1.05-5.16 per 10-year increase; P =.038), patients with advanced clinical T classification (HR, 5.78; 95% CI, 1.60-20.8; P =.007), and patients who were currently using tobacco (HR, 4.38; 95% CI, 1.07-18.0; P =.04). Disease recurrence was associated with advanced clinical T-classification (HR, 8.32; 95% CI, 3.06-23; P <.0001), current/former alcohol use (HR, 13; 95% CI, 1.33-120; P =.03), and unmarried status (HR, 3.28; 95% CI, 1.20-9.00; P =.02). Patients who remained recurrence free for 5 years had an 8.6% chance of recurrence by 10 years (1-sided 95% CI upper bound, 19%; P =.088). CONCLUSIONS In this study, prognostic risk factors were identified for patients with HPV-OSCC. The observed recurrence rates between 5 years and 10 years after definitive therapy need to be validated in additional studies to determine whether extended cancer surveillance is warranted in this cancer population. Cancer 2013;119:3462-3471. © 2013 American Cancer Society. Poor prognostic risk factors for patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma include older patient age, advanced clinical tumor classification, unmarried status, and current tobacco or current/former alcohol use. In this study, a recurrence rate of 8.6% at 5 years is observed after definitive therapy, suggesting that extended cancer surveillance may be warranted for this unique patient population.

Original languageEnglish (US)
Pages (from-to)3462-3471
Number of pages10
JournalCancer
Volume119
Issue number19
DOIs
StatePublished - Oct 1 2013

Keywords

  • head and neck cancer
  • human papillomavirus
  • oropharyngeal cancer
  • risk factors
  • sex

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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