Human papillomavirus and survival of patients with oropharyngeal cancer

New study found that tumor HPV status is a strong and independent prognostic factor for survival among patients with oropharyngeal cancer

Oropharyngeal squamous-cell carcinomas caused by human papillomavirus (HPV) are associated with favorable survival, but the independent prognostic significance of tumor HPV status remains unknown. A group of researchers led by Dr. Maura Gillison of the Ohio State University, USA performed a retrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparing accelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients with squamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive cancer and those with HPV-negative cancer.

The median follow-up period was 4.8 years. The 3-year rate of overall survival was similar in the group receiving accelerated-fractionation radiotherapy and the group receiving standard-fractionation radiotherapy (70.3% vs. 64.3%; P=0.18), as were the rates of high-grade acute and late toxic events. A total of 63.8% of patients with oropharyngeal cancer (206 of 323) had HPV-positive tumors; these patients had better 3-year rates of overall survival (82.4%, vs. 57.1% among patients with HPV-negative tumors; P<0.001 by the log-rank test) and, after adjustment for age, race, tumor and nodal stage, tobacco exposure, and treatment assignment, had a 58% reduction in the risk of death. The risk of death significantly increased with each additional pack-year of tobacco smoking. Using recursive-partitioning analysis, investigators classified patients as having a low, intermediate, or high risk of death on the basis of four factors: HPV status, pack-years of tobacco smoking, tumor stage, and nodal stage.

Researchers concluded that tumor HPV status is a strong and independent prognostic factor for survival among patients with oropharyngeal cancer. Beside researchers from the Ohio State University, the next centers were involved in the study: University of Texas M.D. Anderson Cancer Center, Houston;  Radiation Therapy Oncology Group Statistical Center and Thomas Jefferson University Hospital, both in Philadelphia; Huntsman Cancer Institute, Salt Lake City; Centre Hospitalier de l'Université de Montréal, Montreal; Johns Hopkins University, Baltimore; Vanderbilt University School of Medicine, Nashville; University of Louisville, Louisville; University of California at San Francisco, San Francisco; Wayne State University Medical Center, Detroit; and University of Cincinnati College of Medicine, Cincinnati. The article was published on July 1, 2010 issue of The New England Journal of Medicine.