title: Prognostic significance of human papillomavirus in oropharyngeal squamous cell carcinomas.
abstract: OBJECTIVE
  The human papillomavirus (HPV) has been identified as a causative factor in 20% to 25% of all head and neck squamous cell carcinomas (HNSCC). Ongoing research suggests that the presence of HPV DNA in HNSCC predicts a positive prognosis with respect to disease-free and overall survival. However, most studies have been limited by the heterogeneity in treatment regimens and/or anatomic subsites of tumor origin. In this study, we correlate clinical outcomes with HPV status for patients with oropharyngeal carcinomas who were uniformly treated with a concurrent chemoradiation treatment protocol.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Demographic and clinicopathologic parameters, including age at diagnosis, gender, race, smoking and alcohol history, tumor stage and grade, locoregional recurrence, metastatic spread, recurrence-free survival, overall survival and disease-specific death, were obtained from medical charts and established databases. These parameters were correlated with HPV status of the tumors established by in situ hybridization analysis.
  
  
  RESULTS
  HPV positivity correlated with improved clinical outcomes regarding locoregional control (P = .042), recurrence-free survival (P = .009), overall survival (P = .017), and disease-specific death (P = .09). Advanced T stage was a significant risk factor for recurrence and death independent of HPV status.
  
  
  CONCLUSIONS
  In patients with oropharyngeal carcinoma uniformly treated with chemoradiation, the presence of HPV is a favorable prognostic indicator with respect to recurrence and overall survival. However, advanced T stage was an independent risk factor for recurrence and death that can to some degree offset this benefit.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
authors.forename: Ahmad R
authors.initials: AR
authors.lastname: Sedaghat
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.forename: Shahnaz
authors.initials: S
authors.lastname: Begum
authors.forename: Robert
authors.initials: R
authors.lastname: Palermo
authors.forename: Simon
authors.initials: S
authors.lastname: Best
authors.forename: Karen M
authors.initials: KM
authors.lastname: Ulmer
authors.forename: Marshall
authors.initials: M
authors.lastname: Levine
authors.forename: Eva
authors.initials: E
authors.lastname: Zinreich
authors.forename: Barbara P
authors.initials: BP
authors.lastname: Messing
authors.forename: Dorothy
authors.initials: D
authors.lastname: Gold
authors.forename: Annie A
authors.initials: AA
authors.lastname: Wu
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Niparko
authors.forename: Jeanne
authors.initials: J
authors.lastname: Kowalski
authors.forename: Richard M
authors.initials: RM
authors.lastname: Hirata
authors.forename: John R
authors.initials: JR
authors.lastname: Saunders
authors.forename: William H
authors.initials: WH
authors.lastname: Westra
authors.forename: Sara I
authors.initials: SI
authors.lastname: Pai
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy / Q000821:virology*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000821:virology; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy / Q000821:virology*; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000628:therapy; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome