title: Human papillomavirus in metastatic lymph nodes from unknown primary head and neck squamous cell carcinoma.
abstract: OBJECTIVE
  Determine human papillomavirus (HPV) incidence in unknown primary squamous cell carcinomas (SCCa) of the head and neck and assess if HPV status influenced survival.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Patients with unknown primary SCCa despite a complete workup who underwent neck dissection or excisional biopsy and postoperative comprehensive ± chemoradiotherapy between 2002 and 2009.
  
  
  METHODS
  HPV fluorescence in situ hybridization (FISH) and p16(INK4a) immunohistochemistry (p16 IHC) were performed. Results were compared with survival, age, race, gender, tobacco use, alcohol use, and nodal stage.
  
  
  RESULTS
  Twenty-five patients met the inclusion criteria, of whom 88% were >10 pack year tobacco users. Twenty-eight percent were HPV-positive defined by both p16+ and FISH+. Five-year overall survival was 66.7% in HPV-positive and 48.5% in HPV-negative patients (P = .35). Similarly, 5-year disease-free survival rates were 66.7% in HPV-positive and 48.5% in HPV-negative patients (P = .54). All 3 HPV-positive nonsmokers were survivors, but this was not significant because of the small sample size (P > .05). No other characteristics were associated with survival (P > .05).
  
  
  CONCLUSIONS
  Twenty-eight percent of metastatic lymph nodes from occult primary tumors were HPV positive. There was no survival difference associated with HPV status. Most of the HPV-positive patients in this study were tobacco users who had similar survival to HPV-negative patients, so caution should be used in interpreting HPV status in these patients.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Compton
authors.forename: Tara
authors.initials: T
authors.lastname: Moore-Medlin
authors.forename: Lilantha
authors.initials: L
authors.lastname: Herman-Ferdinandez
authors.forename: Cheryl
authors.initials: C
authors.lastname: Clark
authors.forename: Gloria C
authors.initials: GC
authors.lastname: Caldito
authors.forename: Xiaohong Iris
authors.initials: XI
authors.lastname: Wang
authors.forename: Jaiyeola
authors.initials: J
authors.lastname: Thomas
authors.forename: Fleurette W
authors.initials: FW
authors.lastname: Abreo
authors.forename: Cherie-Ann O
authors.initials: CO
authors.lastname: Nathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000556:secondary* / Q000628:therapy / Q000821:virology*; D003131:Combined Modality Therapy; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000032:analysis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D052162:Human papillomavirus 16; D006801:Humans; D007124:Immunoenzyme Techniques; D017404:In Situ Hybridization, Fluorescence; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000473:pathology* / Q000628:therapy / Q000821:virology*; D010039:Otorhinolaryngologic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000556:secondary* / Q000628:therapy / Q000821:virology*; D030361:Papillomavirus Infections / Q000473:pathology* / Q000601:surgery / Q000821:virology*; D012907:Smoking / Q000009:adverse effects / Q000473:pathology
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16