Korean J Intern Med.  2019 Nov;34(6):1313-1323. 10.3904/kjim.2017.397.

Poor prognostic factors in human papillomavirus-positive head and neck cancer: who might not be candidates for de-escalation treatment?

• Yoo SH
• Ock CY
• Keam B
• Park SJ
• Kim TM
• Kim JH
• Jeon YK
• Chung EJ
• Kwon SK
• Hah JH
• Kwon TK
• Jung KC
• Kim DW
• Wu HG
• Sung MW
• Heo DS

• KMID: 2463490
• DOI: http://doi.org/10.3904/kjim.2017.397

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.

Keyword

Human papillomavirus; Head and neck neoplasms; Overall survival; De-escalation

MeSH Terms

Carcinoma, Squamous Cell
Classification
Diagnosis
Genotype
Head and Neck Neoplasms*
Head*
Humans*
Immunohistochemistry
Male
Neck
Oligonucleotide Array Sequence Analysis
Oropharyngeal Neoplasms
Prognosis
Retrospective Studies
Risk Factors