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

TitleIncreasing prevalence of human papillomavirus-positive oropharyngeal cancers among older adults.
Publication TypeJournal Article
Year of Publication2018
AuthorsWindon MJ, D'Souza G, Rettig EM, Westra WH, van Zante A, Wang SJ, Ryan WR, Mydlarz WK, Ha PK, Miles BA, Koch W, Gourin C, Eisele DW, Fakhry C
Date Published2018 07 15
KeywordsAdult, Age Factors, Aged, California, DNA, Viral, Female, Human papillomavirus 16, Humans, Kaplan-Meier Estimate, Male, Maryland, Middle Aged, Oropharyngeal Neoplasms, Papillomavirus Infections, Prevalence, Prognosis, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck, Young Adult

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 (P = .01) but not among p16-negative patients (P = .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 (P = .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. Cancer 2018;124:2993-9. © 2018 American Cancer Society.

Alternate JournalCancer
PubMed ID29710393
PubMed Central IDPMC6033632
Grant ListP50 DE019032 / DE / NIDCR NIH HHS / United States
R35 DE026631 / DE / NIDCR NIH HHS / United States
T32 DC000027 / DC / NIDCD NIH HHS / United States
Faculty Reference: 
Steven J. Wang, MD