Poor prognostic factors in human papillomavirus-positive head and neck cancer: who might not be candidates for de-escalation treatment?
- Author:
Shin Hye YOO
1
;
Chan Young OCK
;
Bhumsuk KEAM
;
Sung Joon PARK
;
Tae Min KIM
;
Jin Ho KIM
;
Yoon Kyung JEON
;
Eun Jae CHUNG
;
Seong Keun KWON
;
J Hun HAH
;
Tack Kyun KWON
;
Kyeong Chun JUNG
;
Dong Wan KIM
;
Hong Gyun WU
;
Myung Whun SUNG
;
Dae Seog HEO
Author Information
- Publication Type:Original Article
- From:The Korean Journal of Internal Medicine 2019;34(6):1313-1323
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS:Since patients with human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) have favorable outcomes after treatment, treatment de-escalation for these patients is being actively investigated. However, not all HPV-positive HNSCCs are curable, and some patients have a poor prognosis. The purpose of this study was to identify poor prognostic factors in patients with HPV-positive HNSCC.
METHODS:Patients who received a diagnosis of HNSCC and tested positive for HPV from 2000 to 2015 at a single hospital site (n = 152) were included in this retrospective analysis. HPV typing was conducted using the HPV DNA chip assay or liquid bead microarray system. Expression of p16 in the tumors was assessed by immunohistochemistry. To determine candidate factors associated with overall survival (OS), univariate and multivariable Cox regression analyses were performed.
RESULTS:A total of 152 patients with HPV-positive HNSCC were included in this study; 82.2% were male, 43.4% were current or former smokers, and 84.2% had oropharyngeal cancer. By univariate analysis, old age, performance status ≥ 1, non-oropharyngeal location, advanced T classification (T3–4), and HPV genotype 18 were significantly associated with poor OS. By multivariable analysis, performance status ≥ 1 and non-oropharyngeal location were independently associated with shorter OS (hazard ratio [HR], 4.36, p = 0.015; HR, 11.83, p = 0.002, respectively). Furthermore, HPV genotype 18 positivity was also an independent poor prognostic factor of OS (HR, 10.87, p < 0.001).
CONCLUSIONS:Non-oropharyngeal cancer, poor performance status, and HPV genotype 18 were independent poor prognostic factors in patients with HPV-positive HNSCC. Patients with these risk factors might not be candidates for de-escalation treatment.
