Abstract
Objective
To determine if HPV16 infection is associated with improved survival in advanced oropharyngeal squamous cell carcinoma (OPSCC) treated with chemoradiation.
Methods
A retrospective chart review was performed in 44 patients with stage III and IV OPSCC who were treated with curative intent using chemoradiation. Tumor specimens were evaluated for the presence of HPV16 DNA with the in-situ hybridization-catalyzed signal amplification method applied to pre-treatment archival tumor specimens. Tumors were scored as HPV positive if a signal specific to tumor nuclei was detected. Progression-free survival was estimated by Kaplan-Meier analysis. Outcome analyses were performed in the subsets of those with documented local, regional or distant relapse, and in disease-free patients, with a minimum of 2 years for follow-up.
Results
The incidence of HPV16 positive tumors in this patient population was 59%. Overall progression-free survival independent of HPV status was 62%, while survival for patients with HPV16 positive tumors was 78%. Survival of patients with HPV negative tumors was considerably less at 40%. Only HPV status was associated with response to chemoradiation (p=0.006). Patient age, performance status, and tumor stage were not predictive of response. Patients with a history of smoking and heavy alcohol use had an inverse association with HPV status and lower survival in response to chemoradiation (p=.00015).
Conclusions
Patients with OPSCC tumors resulting from HPV16 infection are more likely to respond to platinum-based concurrent chemoradiation, than HPV negative patients with traditional risk factors for oropharyngeal head and neck cancer.
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