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

Authors

  • Brian M. Lin MD,

    1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Hao Wang PhD,

    1. Division of Oncology Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland
    2. Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Gypsyamber D'Souza PhD,

    1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Zhe Zhang MS,

    1. Division of Oncology Biostatistics, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Carole Fakhry MD, MPH,

    1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Andrew W. Joseph MD, MPH,

    1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Virginia E. Drake BA,

    1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Giuseppe Sanguineti MD,

    1. Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • William H. Westra MD,

    1. Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
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  • Sara I. Pai MD, PhD

    Corresponding author
    1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
    2. Department of Oncology, Johns Hopkins Medical Institutions, Baltimore, Maryland
    • Corresponding author: Sara I. Pai, MD, PhD, Departments of Otolaryngology-Head and Neck Surgery and Oncology, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC Sixth Floor, Baltimore, MD 21287; Fax: (410) 955-0035; spai@jhmi.edu

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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.

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