Human papillomavirus predicts outcome in oropharyngeal cancer in patients treated primarily with surgery or radiation therapy.
OBJECTIVE
This study examines the prognostic significance of human papillomavirus (HPV) in patients with locally advanced oropharyngeal squamous cell carcinoma (SCC) treated primarily with surgery or definitive radiotherapy.


METHODS
One hundred and ninety-eight patients with Stage 3/4 SCC were followed up for recurrence in any form or death from any cause for between 1 and 235 months after diagnosis. HPV status was determined using HPV E6-targeted multiplex real-time PCR/p16 immunohistochemistry. Determinants of recurrence and mortality hazards were modelled using Cox's regression with censoring at follow-up dates.


RESULTS
Forty-two per cent of cancers were HPV-positive (87% type 16). HPV predicted loco-regional control, event-free survival and overall survival in multivariable analysis. Within the surgery with adjuvant radiotherapy (n=110), definitive radiotherapy-alone (n=24) and definitive radiotherapy with chemotherapy (n=47) groups, patients with HPV-positive cancers were one-third or less as likely to have loco-regional recurrence, an event or to die of any cause as those with HPV-negative cancers after adjusting for age, gender, tumour grade, AJCC stage and primary site. The 14 patients treated with surgery alone were considered too few for multivariable analysis.


CONCLUSIONS
HPV status predicts better outcome in oropharyngeal cancer treated with surgery plus adjuvant radiotherapy as well as with definitive radiation therapy±chemotherapy.
Department of Radiation Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Building 27, Missenden Road, Camperdown, Sydney, New South Wales 2050, Australia. ahon6809@mail.usyd.edu.au
A M
AM
Hong
T A
TA
Dobbins
C S
CS
Lee
D
D
Jones
G B
GB
Harnett
B K
BK
Armstrong
J R
JR
Clark
C G
CG
Milross
J
J
Kim
C J
CJ
O'Brien
B R
BR
Rose
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D003131:Combined Modality Therapy; D005260:Female; D052163:Human papillomavirus 6 / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000517:prevention & control; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D011237:Predictive Value of Tests; D012008:Recurrence; D014062:Tongue Neoplasms / Q000473:pathology / Q000628:therapy; D014067:Tonsillar Neoplasms / Q000473:pathology / Q000628:therapy