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Int Forum Allergy Rhinol. 2017 Oct;7(10):980-989. doi: 10.1002/alr.21996. Epub 2017 Aug 31.

Significance of human papillomavirus positivity in sinonasal squamous cell carcinoma.

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Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Department of Radiation Oncology, Rutgers New Jersey Medical School, Newark, NJ.
Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, NJ.
Department of Otolaryngology, Harvard Medical School, Boston, MA.
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.
Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, NJ.
Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ.



The role of human papillomavirus (HPV) in sinonasal squamous cell carcinoma (SNSCC) is not well understood.


The National Cancer Database was queried for cases of SNSCC with known HPV status. Demographics, socioeconomic variables, TNM stage, histology, grade, treatment modalities, and overall survival (OS) through 5 years were compared between HPV-positive and HPV-negative tumors. Cox proportional hazard regression analyses were performed.


Seven hundred seventy (770) cases were identified; 526 were HPV-negative (68.3%) and 244 (31.7%) were HPV-positive. Patients with HPV-positive tumors were younger (58.0 vs 63.7 years, p < 0.0001). Nasal cavity (49.4%) tumors were more likely to be HPV-positive (p < 0.05) than maxillary (18.8%), ethmoid (18.8%), and frontal (18.2%) sinus tumors. Large cell nonkeratinizing (42.4%), papillary (42.1%), and basaloid (56.5%) tumors were more likely than keratinizing (25.2%) tumors to be HPV-positive (p < 0.05). Well-differentiated (grade I) tumors (9.0%) were less likely than higher grade tumors to be HPV-positive (p < 0.05). Gender, race, facility type, insurance type, median income, education level, Charlson-Deyo comorbidity score, overall stage, T stage, N stage, M stage, tumor size, treatment modality, surgical approach, and surgical margins did not vary by HPV status (p ≥ 0.05). HPV-positive tumors had higher OS than HPV-negative tumors (p < 0.0001). At 5 years, OS was 68.1% and 51.5% for HPV-positive and HPV-negative tumors, respectively. On multivariate analyses, HPV positivity remained a favorable prognostic factor (hazard ratio, 0.49; 95% confidence interval, 0.34-0.70).


HPV positivity is more common in nasal cavity SCC and nonkeratinizing SNSCC. It is also a favorable prognostic factor in SNSCC. Future studies on SNSCC should take HPV positivity into consideration.


HPV; NCDB; National Cancer Database; human papillomavirus; sinonasal cancer; sinus; squamous cell carcinoma; survival

[Indexed for MEDLINE]

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