Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma Survival: A Comparison by Tumor Site and Initial Treatment

Christian R. Salazar, Richard V. Smith, Madhur K. Garg, Missak Haigentz, Bradley A. Schiff, Nicole Kawachi, Nicole Anayannis, Thomas J. Belbin, Michael B. Prystowsky, Robert D. Burk, Nicolas F. Schlecht

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Recent evidence suggests that human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) patients have better survival than HPV-negative patients. However, it is unclear if similar patterns for survival exist across different tumor sites, and whether HPV-associated prognosis is modified by type of treatment. We prospectively tested 222 histologically confirmed HNSCC primary tumors for HPV DNA by PCR and HPV E6/E7 RNA by RT-PCR prior to treatment at a large urban health center. Cox proportional hazard ratio models were constructed to assess HPV-associated differences in overall and disease-specific survival adjusting for clinical and demographic covariates. HPV detection varied significantly by primary HNSCC tumor site, from 35 % for oropharynx, to 25 % for hypopharynx, 5 % for larynx, and 3 % for oral cavity (p < 0.0001), with HPV16 accounting for the majority (95 %) of HPV-positive tumors. The hazard-risk of overall and disease-specific death comparing HPV16-positive versus negative oropharyngeal HNSCC was reduced by 74 and 89 %, respectively (p values < 0.05), and was independent of other prognostic indicators; no statistically significant changes in outcomes were observed for non-oropharyngeal HNSCC sites. Prediction of overall survival was better with combined DNA and RNA HPV16 positive PCR detection. There was no difference in HPV16-associated survival whether patients received either surgery or (chemo)radiotherapy as their initial treatment modality. Improved HPV-associated HNSCC survival is limited to patients with oropharyngeal primaries. No selective treatment advantage is observed for HPV-positive tumors, although clinical trials are needed to evaluate which treatment modalities provide the most benefit for HPV-positive HNSCC.

Original languageEnglish (US)
Pages (from-to)77-87
Number of pages11
JournalHead and Neck Pathology
Volume8
Issue number1
DOIs
StatePublished - Mar 1 2014
Externally publishedYes

Fingerprint

Cell Survival
Neoplasms
Survival
Therapeutics
Polymerase Chain Reaction
Carcinoma, squamous cell of head and neck
RNA
Urban Health
Hypopharynx
Oropharynx
DNA
Larynx
Proportional Hazards Models
Mouth
Radiotherapy
Demography
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Pathology and Forensic Medicine
  • Otorhinolaryngology
  • Oncology

Cite this

Salazar, Christian R. ; Smith, Richard V. ; Garg, Madhur K. ; Haigentz, Missak ; Schiff, Bradley A. ; Kawachi, Nicole ; Anayannis, Nicole ; Belbin, Thomas J. ; Prystowsky, Michael B. ; Burk, Robert D. ; Schlecht, Nicolas F. / Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma Survival : A Comparison by Tumor Site and Initial Treatment. In: Head and Neck Pathology. 2014 ; Vol. 8, No. 1. pp. 77-87.
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title = "Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma Survival: A Comparison by Tumor Site and Initial Treatment",
abstract = "Recent evidence suggests that human papillomavirus (HPV)-positive head and neck squamous cell carcinoma (HNSCC) patients have better survival than HPV-negative patients. However, it is unclear if similar patterns for survival exist across different tumor sites, and whether HPV-associated prognosis is modified by type of treatment. We prospectively tested 222 histologically confirmed HNSCC primary tumors for HPV DNA by PCR and HPV E6/E7 RNA by RT-PCR prior to treatment at a large urban health center. Cox proportional hazard ratio models were constructed to assess HPV-associated differences in overall and disease-specific survival adjusting for clinical and demographic covariates. HPV detection varied significantly by primary HNSCC tumor site, from 35 {\%} for oropharynx, to 25 {\%} for hypopharynx, 5 {\%} for larynx, and 3 {\%} for oral cavity (p < 0.0001), with HPV16 accounting for the majority (95 {\%}) of HPV-positive tumors. The hazard-risk of overall and disease-specific death comparing HPV16-positive versus negative oropharyngeal HNSCC was reduced by 74 and 89 {\%}, respectively (p values < 0.05), and was independent of other prognostic indicators; no statistically significant changes in outcomes were observed for non-oropharyngeal HNSCC sites. Prediction of overall survival was better with combined DNA and RNA HPV16 positive PCR detection. There was no difference in HPV16-associated survival whether patients received either surgery or (chemo)radiotherapy as their initial treatment modality. Improved HPV-associated HNSCC survival is limited to patients with oropharyngeal primaries. No selective treatment advantage is observed for HPV-positive tumors, although clinical trials are needed to evaluate which treatment modalities provide the most benefit for HPV-positive HNSCC.",
author = "Salazar, {Christian R.} and Smith, {Richard V.} and Garg, {Madhur K.} and Missak Haigentz and Schiff, {Bradley A.} and Nicole Kawachi and Nicole Anayannis and Belbin, {Thomas J.} and Prystowsky, {Michael B.} and Burk, {Robert D.} and Schlecht, {Nicolas F.}",
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Salazar, CR, Smith, RV, Garg, MK, Haigentz, M, Schiff, BA, Kawachi, N, Anayannis, N, Belbin, TJ, Prystowsky, MB, Burk, RD & Schlecht, NF 2014, 'Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma Survival: A Comparison by Tumor Site and Initial Treatment', Head and Neck Pathology, vol. 8, no. 1, pp. 77-87. https://doi.org/10.1007/s12105-013-0486-4

Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma Survival : A Comparison by Tumor Site and Initial Treatment. / Salazar, Christian R.; Smith, Richard V.; Garg, Madhur K.; Haigentz, Missak; Schiff, Bradley A.; Kawachi, Nicole; Anayannis, Nicole; Belbin, Thomas J.; Prystowsky, Michael B.; Burk, Robert D.; Schlecht, Nicolas F.

In: Head and Neck Pathology, Vol. 8, No. 1, 01.03.2014, p. 77-87.

Research output: Contribution to journalArticle

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T1 - Human Papillomavirus-Associated Head and Neck Squamous Cell Carcinoma Survival

T2 - A Comparison by Tumor Site and Initial Treatment

AU - Salazar, Christian R.

AU - Smith, Richard V.

AU - Garg, Madhur K.

AU - Haigentz, Missak

AU - Schiff, Bradley A.

AU - Kawachi, Nicole

AU - Anayannis, Nicole

AU - Belbin, Thomas J.

AU - Prystowsky, Michael B.

AU - Burk, Robert D.

AU - Schlecht, Nicolas F.

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