title: Longer survival in patients with human papillomavirus-related head and neck cancer after positive postradiation planned neck dissection.
abstract: BACKGROUND
  The purpose of this study was to compare outcomes between human papillomavirus (HPV)-related versus -unrelated head and neck cancer after pathological positive planned neck dissection.
  
  
  METHODS
  Positive planned neck dissection for head and neck cancers from 1998 to 2010 were included in this study. Outcomes after planned neck dissection were compared between HPV-related versus -unrelated cohorts. Multivariate analysis identified survival predictors.
  
  
  RESULTS
  HPV-related head and neck cancer (n = 32) had better 5-year overall survival (48% vs 27%; p = .021), marginally lower second malignancy (7% vs 16%; p = .13), but similar local, regional, and distant control (87% vs 89%; 94% vs 89%; 62% vs 58%, respectively) versus HPV unrelated (n = 38). HPV status conferred reduced risk of death (hazard ratio [HR], 0.5; p = .038) after adjusting for age, smoking, and initial T and N classifications.
  
  
  CONCLUSIONS
  This study reveals that positive planned neck dissection for HPV-related head and neck cancer represents a biologic unfavorable subset of the HPV population with unsatisfactory survival attributable to distant metastasis. The longer survival compared to the HPV-unrelated counterpart is likely related to a marginally lower second malignancy rather than better disease control.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Shao Hui
authors.initials: SH
authors.lastname: Huang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Samip
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.|Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada.
authors.forename: Xiaowei
authors.initials: X
authors.lastname: Shen
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Pathology, Princess Margaret Centre, Toronto, Canada.
authors.forename: Ilan
authors.initials: I
authors.lastname: Weinreb
authors.affiliation: Department of Pathology, Princess Margaret Centre, Toronto, Canada.
authors.forename: Bayardo
authors.initials: B
authors.lastname: Perez-Ordonez
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.|Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Waldron
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Gullane
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gilbert
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Dale
authors.initials: D
authors.lastname: Brown
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Freeman
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goldstein
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000532:radiotherapy / Q000821:virology; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000401:mortality* / Q000532:radiotherapy / Q000821:virology; D011379:Prognosis; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
keywords: head and neck cancer; human papillomavirus; planned neck dissection; radiotherapy; survival