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Friday, March 21, 2014

Better survival even after disease progression in HPV-positive head and neck cancer

Human papillomavirus (HPV)-positive tumor status is associated with a significantly better rate of overall survival in patients with oropharyngeal squamous cell carcinoma (OPSCC) that has progressed, according to Carole Fakhry, MD, and colleagues of Johns Hopkins Medical Center, Baltimore, Maryland.

Previous studies has shown reduced risk of cancer progression in patients with newly diagnosed local-regionally HPV-positive OPSCC. However, no information was available regarding the role of the HPV status in overall survival after cancer had progressed.

The retrospective study evaluated 181 patients with stage III-IV OPSCC, and included 105 who were HPV-positive and 76 who were HPV-negative.

Even though no difference was found in the median time to progression in relation to the HPV tumor status (8.2 vs 7.3 months; P = .67), HPV-positive OPSCC had significantly improved rates of overall survival at 2 years compared with HPV-negative patients (54.6% vs 27.6%; P< .001).

Factors significantly associated with increased risk of death included high tumor stage (T4 vs T2-3) at diagnosis, fewer cisplatin treatment cycles (≤1 vs 2-3), and distant versus local/regional recurrence. Smoking was also an important risk factor, with the risk of death after progression increased by 1% per cigarette pack-year at diagnosis (P = .002).

Significant reductions in the risk of death were associated with HPV-positive tumor status and undergoing salvage surgery. The overall rate of mortality was reduced by 50% in individual with HPV-positive tumors.

Sites of HPV oral cancer