title: Predictors of overall survival in human papillomavirus-associated oropharyngeal cancer using the National Cancer Data Base.
abstract: OBJECTIVE
  This study identifies clinical characteristics associated with HPV-positive oropharynx squamous cell carcinoma (OPSCC) and evaluates predictors of overall survival (OS) in HPV-positive patients undergoing definitive treatment within the National Cancer Data Base (NCDB).
  
  
  METHODS
  The NCDB was queried for patients ⩾18years old with OPSCC and known HPV status who underwent definitive treatment: surgery, radiation (RT), chemotherapy-RT (CRT), surgery+RT, surgery+CRT (S-CRT). Cox proportional hazards model was used for multivariate analysis (MVA) to evaluate predictors of OS by HPV status.
  
  
  RESULTS
  3952 patients were included: 2454 (62%) were HPV-positive. Median follow up was 23.7months (range, 1.0-54.5). Unadjusted 2-year OS rates for HPV-positive vs. negative were 93.1% vs. 77.8% (p<0.001) with an adjusted hazard ratio of 0.44 (95% CI, 0.36-0.53; p<0.001). MVA identified multimodality treatment including CRT (HR, 0.42; p=0.024) and S-RT (HR, 0.30; p=0.024), but not S-CRT (HR, 0.51; p=0.086), as predictors for improved OS in HPV-positive stage III-IVB disease. Multimodality treatment including S-CRT was associated with longer OS in HPV-negative OPSCC. Nodal stage was poorly associated with OS in HPV-positive cancers. The presence of positive margins and/or extracapsular extension was associated with worse OS in HPV-negative (HR, 2.11; p=0.008) but not HPV positive OPSCC (HR, 1.61; p=0.154).
  
  
  CONCLUSIONS
  The established demographic and clinical features of HPV-positive OPSCC were corroborated in the NCDB. Population analysis suggests that AJCC staging is poorly associated with OS in HPV-positive cancer, and traditional high-risk features may be less impactful. Bimodality therapy appears beneficial in HPV-positive HNSCC.
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: arya.amini@ucdenver.edu.
authors.forename: Arya
authors.initials: A
authors.lastname: Amini
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Jagar
authors.initials: J
authors.lastname: Jasem
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Bernard L
authors.initials: BL
authors.lastname: Jones
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Tyler P
authors.initials: TP
authors.lastname: Robin
authors.affiliation: Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA; Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Jessica D
authors.initials: JD
authors.lastname: McDermott
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: David
authors.initials: D
authors.lastname: Raben
authors.affiliation: Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Antonio
authors.initials: A
authors.lastname: Jimeno
authors.affiliation: Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA; Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Bowles
authors.affiliation: Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: sana.karam@ucdenver.edu.
authors.forename: Sana D
authors.initials: SD
authors.lastname: Karam
mesh_terms: D000368:Aged; D052685:Alphapapillomavirus / Q000302:isolation & purification*; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000821:virology; D003628:Database Management Systems; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000821:virology; D016019:Survival Analysis
keywords: Chemoradiation; Head and neck squamous cell carcinoma; Human papillomavirus (HPV); National Cancer Data Base (NCDB); Oropharynx cancer; Survival outcomes