title: Impact of p16 expression, nodal status, and smoking on oncologic outcomes of patients with head and neck unknown primary squamous cell carcinoma.
abstract: The prognostic significance of human papillomavirus (HPV) in the context of head and neck squamous cell carcinoma (HNSCC) of cancer of unknown primary (CUP) origin is unclear.
  
  
  
  Patients treated for CUP at the Princess Margaret Cancer Centre between 2001 and 2013 were stratified by p16 status and retrospectively reviewed.
  
  
  
  Of the 73 patients included, those with p16-positive tumors (63%) had less advanced nodal status (N1-N2b; 52% vs 89%; p = .035) and less aggressive treatment. Patients with p16-positive tumors had improved 3-year disease-free survival (DFS; 79% vs 56%; p = .012) independent of nodal status and treatment in multivariable analysis (hazard ratio [HR] = 0.27; 95% confidence interval [CI] = 0.08-0.95).
  
  
  
  Among patients with CUP, p16-positive status is an independent predictor of DFS but not overall survival (OS). © 2016 Wiley Periodicals, Inc. Head Neck, 2016 © 2016 Wiley Periodicals, Inc. Head Neck 38: 1347-1353, 2016.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Peter R
authors.initials: PR
authors.lastname: Dixon
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Au
authors.forename: Ali
authors.initials: A
authors.lastname: Hosni
authors.affiliation: Department of Pathology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Bayardo
authors.initials: B
authors.lastname: Perez-Ordonez
authors.affiliation: Department of Pathology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Ilan
authors.initials: I
authors.lastname: Weinreb
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Yuyao
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Shao Hui
authors.initials: SH
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Goldstein
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: de Almeida
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002173:Cancer Care Facilities; D002294:Carcinoma, Squamous Cell / Q000378:metabolism* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000378:metabolism*; D005260:Female; D006258:Head and Neck Neoplasms / Q000378:metabolism* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D009864:Ontario; D027383:Papillomaviridae / Q000302:isolation & purification; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects / Q000401:mortality; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D019941:Cyclin-Dependent Kinase Inhibitor p16
keywords: head and neck neoplasms; human papilloma virus; p16; squamous cell carcinoma; unknown primary neoplasms