title: Human papillomavirus outcomes in an access-to-care laryngeal cancer cohort.
abstract: OBJECTIVE
  Human papillomavirus (HPV), particularly HPV16, is a causative agent for 25% of head and neck squamous cell cancer, including laryngeal squamous cell cancer (LSCC). HPV-positive (HPV+ve) patients, particularly those with oropharyngeal SCC, have improved prognosis. For LSCC patients, this remains to be established. The goal was to determine stage and survival outcomes in LSCC in the context of HPV infection.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  Primary care academic health system.
  
  
  METHODS
  In 79 patients with primary LSCC, HPV was determined using real-time quantitative polymerase chain reaction. χ(2) or Fisher exact test was used to test the association of HPV+ve with 21 risk factors including race, stage, gender, age, smoking, alcohol, treatment, and health insurance. Kaplan-Meier and log-rank tests were used to study the association of HPV and LSCC survival outcome.
  
  
  RESULTS
  HPV16 was detected in 27% of LSCC patients. Caucasian American (CA) patients had higher HPV prevalence (33%) than did African American (AA) LSCC patients (16%; P = .058). HPV was significantly associated with gender (P = .016) and insurance type (P = .001). There were no differences in survival between HPV+ve and HPV-negative (HPV-ve) patients. There was no association with HPV and other risk factors including stage (early vs late).
  
  
  CONCLUSIONS
  We found a high prevalence of HPV in men and a lower prevalence of HPV infection in AA compared with CA. Despite the strikingly better survival of patients with HPV+ve oropharyngeal tumors, even when adjusted for smoking, this correlation does not seem to hold true in the larynx. Larger multiethnic LSCC cohorts are needed to more clearly delineate HPV-related survival across ethnicities.
authors.affiliation: Department of Otolaryngology/Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan 48202, USA. jstephe2@hfhs.org
authors.forename: Josena K
authors.initials: JK
authors.lastname: Stephen
authors.forename: Kang Mei
authors.initials: KM
authors.lastname: Chen
authors.forename: Veena
authors.initials: V
authors.lastname: Shah
authors.forename: Shaleta
authors.initials: S
authors.lastname: Havard
authors.forename: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Vanessa P
authors.initials: VP
authors.lastname: Schweitzer
authors.forename: Glendon
authors.initials: G
authors.lastname: Gardner
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Worsham
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000821:virology*; D016009:Chi-Square Distribution; D005260:Female; D052162:Human papillomavirus 16 / Q000302:isolation & purification*; D006801:Humans; D007822:Laryngeal Neoplasms / Q000821:virology*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology / Q000208:ethnology; D015995:Prevalence; D011379:Prognosis; D060888:Real-Time Polymerase Chain Reaction; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate