Format

Send to

Choose Destination
Oral Oncol. 2016 May;56:1-7. doi: 10.1016/j.oraloncology.2016.02.011. Epub 2016 Mar 12.

Predictors of overall survival in human papillomavirus-associated oropharyngeal cancer using the National Cancer Data Base.

Author information

1
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: arya.amini@ucdenver.edu.
2
Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
3
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
4
Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA; Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
5
Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
6
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: sana.karam@ucdenver.edu.

Abstract

OBJECTIVES:

This study identifies clinical characteristics associated with HPV-positive oropharynx squamous cell carcinoma (OPSCC) and evaluates predictors of overall survival (OS) in HPV-positive patients undergoing definitive treatment within the National Cancer Data Base (NCDB).

MATERIAL AND METHODS:

The NCDB was queried for patients ⩾18years old with OPSCC and known HPV status who underwent definitive treatment: surgery, radiation (RT), chemotherapy-RT (CRT), surgery+RT, surgery+CRT (S-CRT). Cox proportional hazards model was used for multivariate analysis (MVA) to evaluate predictors of OS by HPV status.

RESULTS:

3952 patients were included: 2454 (62%) were HPV-positive. Median follow up was 23.7months (range, 1.0-54.5). Unadjusted 2-year OS rates for HPV-positive vs. negative were 93.1% vs. 77.8% (p<0.001) with an adjusted hazard ratio of 0.44 (95% CI, 0.36-0.53; p<0.001). MVA identified multimodality treatment including CRT (HR, 0.42; p=0.024) and S-RT (HR, 0.30; p=0.024), but not S-CRT (HR, 0.51; p=0.086), as predictors for improved OS in HPV-positive stage III-IVB disease. Multimodality treatment including S-CRT was associated with longer OS in HPV-negative OPSCC. Nodal stage was poorly associated with OS in HPV-positive cancers. The presence of positive margins and/or extracapsular extension was associated with worse OS in HPV-negative (HR, 2.11; p=0.008) but not HPV positive OPSCC (HR, 1.61; p=0.154).

CONCLUSION:

The established demographic and clinical features of HPV-positive OPSCC were corroborated in the NCDB. Population analysis suggests that AJCC staging is poorly associated with OS in HPV-positive cancer, and traditional high-risk features may be less impactful. Bimodality therapy appears beneficial in HPV-positive HNSCC.

KEYWORDS:

Chemoradiation; Head and neck squamous cell carcinoma; Human papillomavirus (HPV); National Cancer Data Base (NCDB); Oropharynx cancer; Survival outcomes

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science Icon for University of Colorado, Strauss Health Sciences Library
Loading ...
Support Center