Li H, et al. - Authors evaluated if human papillomavirus (HPV) positivity at each head and neck subsite was related to improved overall survival. An association of human papillomavirus positivity with improved survival in 4 subsites (oropharynx, hypopharynx, oral cavity, and larynx), and the largest survival difference was seen in the oropharynx and hypopharynx subsites. HPV positivity had no association with overall survival in the nasopharynx and sinonasal tract subsites. In view of these findings, routine testing for HPV at the oropharynx, hypopharynx, oral cavity, and larynx subsites could be suggested.

Methods

• Researchers ascertained if HPV positivity at each head and neck subsite was related to improved overall survival.
• To identify patients diagnosed with head and neck squamous cell carcinomas from January 1, 2010, to December 31, 2014, this retrospective population-based cohort study used the National Cancer Database.
• They classified patients according to the location of their primary malignancy into 1 of the 6 main subsites of the upper aerodigestive tract: oral cavity, oropharynx, nasopharynx, hypopharynx, larynx, and sinonasal tract.
• They also classified the patients by their HPV status.
• For this study, data collection took place from January 1, 2010, to December 31, 2014.
• From August 1, 2017, to September 30, 2017, data analysis was conducted.
• The main outcomes and measures were the difference in 5-year overall survival between patients with HPV-positive status and those with HPV-negative status in various head and neck carcinoma subsites; the role of HPV status in an unadjusted Cox multivariate regression model.

Results

• Findings suggested that out of the 175,223 total number of patients identified (129 634 [74.0%] male; 45 589 [26.0%] female; mean [SD] age, 63.1 [11.9] years), 133,273 (76.1%) were ineligible and 41,950 (23.9%) were included in the sample.
• As per data, in this sample 16,644 patients (39.7%) with HPV-positive tumors were included and 25,306 (60.3%) with HPV-negative tumors.
• Data suggested a greater likeliness of patients with an HPV-positive status to be younger, be white, be male, present with local T category tumors, and have poor differentiation on histologic examination.
• Experts noted an association of HPV-positive status with survival at 4 tumor subsites: oral cavity (hazard ratio [HR], 0.76; 95% CI, 0.66-0.87), oropharynx (HR, 0.44; 95% CI, 0.41-0.47), hypopharynx (HR, 0.59; 95% CI, 0.45-0.77), and larynx (HR, 0.71; 95% CI, 0.59-0.85).
• In survival outcome, the HPV status was the greatest factor between the HPV-positive and -negative cohorts at the oropharynx subsite (77.6% vs 50.7%; survival difference, 26.9%; 95% CI, 25.6%-28.2%) and hypopharynx subsites (52.2% vs 28.8%; survival difference, 23.4%; 95% CI, 17.5%-29.3%).
• HPV-positive status was not an independent prognostic factor, for the nasopharynx (HR, 1.03; 95% CI, 0.75-1.42) and sinonasal tract (HR, 0.63; 95% CI, 0.39-1.01) subsites.