Prognostic factors for human papillomavirus-positive and negative oropharyngeal carcinomas.

TitlePrognostic factors for human papillomavirus-positive and negative oropharyngeal carcinomas.
Publication TypeJournal Article
Year of Publication2018
AuthorsYin LX, D'Souza G, Westra WH, Wang SJ, van Zante A, Zhang Y, Rettig EM, Ryan WR, Ha PK, Wentz A, Koch W, Eisele DW, Fakhry C
Date Published2018 08
KeywordsCarcinoma, Female, Hispanic or Latino, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Oropharyngeal Neoplasms, Papillomaviridae, Papillomavirus Infections, Prognosis, Proportional Hazards Models, Racial Groups, Regression Analysis, Retrospective Studies, Risk Factors, Sex Factors

OBJECTIVES/HYPOTHESIS: Human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) are distinct disease entities. Prognostic factors specific to each entity have not been adequately explored. Goals for this study were: 1) to determine whether HPV-positive and HPV-negative OPSCCs have distinct prognostic factors, and 2) to explore the prognostic significance of sex and race in OPSCC after HPV stratification STUDY DESIGN: Retrospective case series.

METHODS: A retrospective review of 239 incident OPSCC patients from 1995 to 2012, treated at Johns Hopkins and University of California-San Francisco was conducted. Women and nonwhite races were oversampled. All analyses were stratified by tumor HPV in situ hybridization status. The effects of sex and race on survival were considered in Kaplan-Meier and unadjusted and adjusted Cox regression models.

RESULTS: One hundred thirty-four (56.1%) OPSCC patients were HPV positive. On univariate analysis, women had better overall survival than men among HPV-positive (hazard ratio [HR]: 0.47, 95% confidence interval [CI]: 0.20-1.07; P = .06) but not HPV-negative (HR: 0.73, 95% CI: 0.43-1.24; P = .24) OPSCCs. On multivariate analysis, women with HPV-positive OPSCCs remained at lower risk of death (adjusted hazard ratio [aHR]: 0.34, 95% CI: 0.12-0.96; P = .04). Survival did not vary significantly by race among HPV-positive patients. Among HPV-negative patients, Hispanic patients had significantly better survival in unadjusted (HR: 0.27, 95% CI: 0.08-0.91; P = .04) but not adjusted (aHR: 0.93, 95% CI: 0.11-7.36; P = .94) analysis.

CONCLUSIONS: Women with HPV-positive OPSCC may have improved overall survival compared to men. Sex does not play a prognostic role in HPV-negative OPSCC. There are no differences in prognosis by race among HPV-positive or HPV-negative patients.

LEVEL OF EVIDENCE: 4 Laryngoscope, E287-E295, 2018.

Alternate JournalLaryngoscope
PubMed ID29536542
PubMed Central IDPMC8929688
Grant ListP50 DE019032 / DE / NIDCR NIH HHS / United States
R35 DE026631 / DE / NIDCR NIH HHS / United States
Faculty Reference: 
Steven J. Wang, MD