title: HPV-Positive Oropharyngeal Carcinoma: A Systematic Review of Treatment and Prognosis.
abstract: OBJECTIVE
  Human papillomavirus-positive (HPV+) head and neck squamous cell carcinoma is increasing in incidence and appears to exhibit improved response to treatment and better survival than that of HPV- head and neck squamous cell carcinoma. The purpose of this systematic review was to examine the current literature regarding treatment and prognosis of HPV+ oropharyngeal squamous cell carcinoma (OPSCC) and identify whether type of treatment (primarily surgery vs primarily radiation) significantly affects survival rates.
  
  
  METHODS
  PubMed and Cochrane Library databases.
  
  
  METHODS
  A computerized search of the PubMed and Cochrane Library databases was performed to identify English-language articles published between January 1, 2000, and October 21, 2014. Studies were included only if they were prospective or retrospective observational series of OPSCC patients that reported HPV status, treatment regimen, and survival outcomes. Outcomes were determined for HPV+ and HPV- OPSCC patients, with subanalyses according to the type of treatment received.
  
  
  RESULTS
  Fifty-six articles were eligible for this review. In the HPV+ analysis, the unadjusted hazard rate ratio (HR) for surgery vs radiation treatment was 1.33 (P = .114). Nine confounders were considered, and HRs were adjusted for each covariate. While HRs were almost all >1 for all covariates, none of the HRs was statistically significant at P < .05. The HR for HPV- OPSCC was higher for radiation than surgery.
  
  
  CONCLUSIONS
  HPV+ OPSCC has an improved prognosis and lower rates of adverse events when compared with HPV- OPSCC. HPV- OPSCC had significantly worse outcomes when treated with primary radiation as compared with primary surgery. There was no statistically significant difference in HRs for HPV+ OPSCC with primary radiation vs primary surgery treatment.
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA mbwang@ucla.edu.
authors.forename: Marilene B
authors.initials: MB
authors.lastname: Wang
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Isabelle Y
authors.initials: IY
authors.lastname: Liu
authors.affiliation: Statistical/Biomathematical Consulting Clinic, Department of Biomathematics, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Gornbein
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California, USA Anacapa Surgical Associates, Ventura, California, USA.
authors.forename: Chau T
authors.initials: CT
authors.lastname: Nguyen
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000628:therapy / Q000821:virology; D003131:Combined Modality Therapy; D004279:DNA, Viral / Q000032:analysis*; D014943:Global Health; D006801:Humans; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000628:therapy / Q000821:virology; D027383:Papillomaviridae / Q000235:genetics*; D030361:Papillomavirus Infections / Q000401:mortality / Q000628:therapy / Q000821:virology; D011379:Prognosis; D012042:Registries; D015996:Survival Rate / Q000639:trends
chemical_list: D004279:DNA, Viral
keywords: HPV; head and neck cancer; human papillomavirus; oropharyngeal squamous cell carcinoma; p16; radiation; surgery