title: Long-term prognosis and risk factors among patients with HPV-associated oropharyngeal squamous cell carcinoma.
abstract: BACKGROUND
  A subset of patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV-OSCC) experience poor clinical outcomes. The authors of this report explored prognostic risk factors for overall survival (OS) and recurrence-free survival (RFS).
  
  
  METHODS
  Patients with incident HPV-OSCC who received treatment at the Johns Hopkins Hospital between 1997 and 2008 and who had tissue available for HPV testing as well as demographic and clinicopathologic information (N = 176) were included. Tissue was tested for HPV by in situ hybridization (ISH) and/or p16 immunohistochemistry. Demographic and clinicopathologic information was extracted from medical records.
  
  
  RESULTS
  In total, 157 of 176 patients (90%) with OSCC had HPV-associated disease (HPV-OSCC). In the patients with HPV-OSCC, the 3-year and 5-year OS rates were 93% (95% confidence interval [CI], 88%-98%) and 89% (95% CI, 81%-97%), respectively. Shorter survival was observed among older patients (hazard ratio [HR], 2.33 per 10-year increase; 95% CI, 1.05-5.16 per 10-year increase; P = .038), patients with advanced clinical T classification (HR, 5.78; 95% CI, 1.60-20.8; P = .007), and patients who were currently using tobacco (HR, 4.38; 95% CI, 1.07-18.0; P = .04). Disease recurrence was associated with advanced clinical T-classification (HR, 8.32; 95% CI, 3.06-23; P < .0001), current/former alcohol use (HR, 13; 95% CI, 1.33-120; P = .03), and unmarried status (HR, 3.28; 95% CI, 1.20-9.00; P = .02). Patients who remained recurrence free for 5 years had an 8.6% chance of recurrence by 10 years (1-sided 95% CI upper bound, 19%; P = .088).
  
  
  CONCLUSIONS
  In this study, prognostic risk factors were identified for patients with HPV-OSCC. The observed recurrence rates between 5 years and 10 years after definitive therapy need to be validated in additional studies to determine whether extended cancer surveillance is warranted in this cancer population. Cancer 2013;119:3462-3471.. © 2013 American Cancer Society.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Lin
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: D'Souza
authors.forename: Zhe
authors.initials: Z
authors.lastname: Zhang
authors.forename: Carole
authors.initials: C
authors.lastname: Fakhry
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Joseph
authors.forename: Virginia E
authors.initials: VE
authors.lastname: Drake
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
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; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000628:therapy* / Q000821:virology*; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000473:pathology* / Q000821:virology; D011379:Prognosis; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: head and neck cancer; human papillomavirus; oropharyngeal cancer; risk factors; sex