HPV positivity may improve survival in some nonoropharyngeal head and neck cancers
medwireNews: Human papillomavirus (HPV) positivity is associated with improved survival in patients with head and neck cancer at four of six subsites in the upper aerodigestive tract, US study findings indicate.
“Given these results, routine testing for HPV at the oropharynx, hypopharynx, oral cavity, and larynx subsites may be warranted,” Benjamin Judson (Yale University School of Medicine, New Haven, Connecticut) and colleagues remark.
The retrospective, population-based cohort study involved 41,950 patients with head and neck squamous cell carcinoma (SCC), who were registered in the US National Cancer Database between 2010 and 2014. Of these, 16,644 (39.7%) were positive for HPV-16 and/or HPV-18.
Patients who were positive for HPV were more likely to be younger, White, male, and present with poorly differentiated, local T category tumors, compared with their HPV-negative counterparts.
The researchers found that 5-year survival rates were higher among HPV-positive patients than among HPV-negative patients with tumors in the oropharynx (77.6 vs 50.7%), hypopharynx (52.2 vs 28.8%), oral cavity (59.4 vs 53.1%), larynx (57.2 vs 48.7%), and sinonasal tract (63.1 vs 45.1%), but not at the nasopharynx (52.5 vs 58.7%).
On multivariate analysis, adjusted for potential confounders, HPV-positive status was associated with a significantly reduced risk for death at 5 years among patients with tumors in the oropharynx (hazard ratio [HR]=0.44), hypopharynx (HR=0.59), larynx (HR=0.71), and oral cavity (HR=0.76).
By contrast, HPV status had no impact on survival among patients with tumors in the nasopharynx or sinonasal tract.
“These results suggest that a variance in the magnitude of survival benefit [associated with HPV-positivity] exist[s] between the subsites, providing a foundation for further study,” Judson and co-authors write in JAMA Otolaryngology–Head & Neck Surgery.
In an accompanying commentary, William Ryan and Karolina Plonowska, both from the University of California, San Francisco in the USA, describe the findings as “persuasive.”
They explain: “Previous studies with smaller sample sizes have similarly suggested the favorable prognostic role of HPV in cancer in nonoropharyngeal head and neck sites, although other studies have refuted this possibility.”
Ryan and Plonowska add: “Perhaps with more detailed, corroborative evidence, we could consider select deintensified treatment efforts for these nonoropharyngeal SCC subsites on the basis of HPV positivity.”
By Laura Cowen
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