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Thursday, September 17, 2015

Persistence of HPV in saliva of patients with oropharyngeal carcinoma predicts recurrence

Human papillomavirus–related oropharyngeal carcinoma (HPV-OPC) is increasing in incidence in the United States. Although HPV-OPC has favorable prognosis, 10% to 25% of HPV-OPCs recur. Detection of human papillomavirus (HPV) DNA in oral rinses is associated with HPV-OPC, but its potential as was unclear.

Rettig et al. determined whether HPV DNA detection in oral rinses after treatment for HPV-OPC is a  prognostic biomarker that  associated with recurrence and survival.

The investigators studied 124 patients with HPV-OPC.  Oral rinse samples were collected at diagnosis and after treatment (9, 12, 18, and 24 months after diagnosis), and evaluated for HPV DNA.

Oral HPV type 16 (HPV16) DNA was common at diagnosis (67 of 124 participants [54%]). Oral HPV16 DNA persisted in only 6 participants after treatment (5%).  Two-year disease-free survival (DFS) and overall survival (OS)  were 92%  and 98%. Persistent oral HPV16 DNA was associated with worse DFS and OS . All 5 participants with persistent oral HPV16 DNA developed recurrent disease, 3 with local disease involvement. In contrast, just 9 of 119 participants (8%) without persistent oral HPV16 DNA developed recurrent disease, only 1 (11%) with local disease involvement. Median (range) time from earliest posttreatment oral HPV16 DNA detection to recurrence was 7.0 (3.7-10.9) months.

This study illustrates that although HPV type 16 DNA in oral rinses is common at diagnosis, it is rare after treatment for HPV-OPC. Detection of HPV16 DNA in oral rinses after treatment for HPV-OPC may be a useful adjunct to current post-treatment tumor surveillance strategies, potentially facilitating earlier diagnosis of progressive or recurrent HPV-OPC. This may enable earlier intervention and the administration of proper surgical and medical treatment.