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Prognostic significance of human papillomavirus in oropharyngeal squamous cell carcinomas

Authors

  • Ahmad R. Sedaghat MD, PhD,

    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Zhe Zhang MS,

    1. Department of Oncology Biostatistics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Shahnaz Begum PhD,

    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Robert Palermo MD,

    1. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • Simon Best MD,

    1. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • Karen M. Ulmer RN,

    1. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • Marshall Levine MD,

    1. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • Eva Zinreich MD,

    1. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • Barbara P. Messing MA, CCC-SLP,

    1. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • Dorothy Gold,

    1. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • Annie A. Wu,

    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Kevin J. Niparko,

    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Jeanne Kowalski PhD,

    1. Department of Oncology Biostatistics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Richard M. Hirata MD,

    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • John R. Saunders MD,

    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center, Baltimore, Maryland, U.S.A.
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  • William H. Westra MD,

    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
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  • Sara I. Pai MD, PhD

    Corresponding author
    1. Department of Otolaryngology/Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
    • Department of Otolaryngology/Head and Neck Surgery, Johns Hopkins Medical Institutions, 601 North Caroline Street, Baltimore, MD 21287
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  • This work was supported by The Milton J. Dance, Jr. Head and Neck Center at Greater Baltimore Medical Center Neck Center, Baltimore, Maryland.

  • The authors have no conflicting financial interests.

Abstract

Objectives/Hypothesis:

The human papillomavirus (HPV) has been identified as a causative factor in 20% to 25% of all head and neck squamous cell carcinomas (HNSCC). Ongoing research suggests that the presence of HPV DNA in HNSCC predicts a positive prognosis with respect to disease-free and overall survival. However, most studies have been limited by the heterogeneity in treatment regimens and/or anatomic subsites of tumor origin. In this study, we correlate clinical outcomes with HPV status for patients with oropharyngeal carcinomas who were uniformly treated with a concurrent chemoradiation treatment protocol.

Study Design:

Retrospective study.

Methods:

Demographic and clinicopathologic parameters, including age at diagnosis, gender, race, smoking and alcohol history, tumor stage and grade, locoregional recurrence, metastatic spread, recurrence-free survival, overall survival and disease-specific death, were obtained from medical charts and established databases. These parameters were correlated with HPV status of the tumors established by in situ hybridization analysis.

Results:

HPV positivity correlated with improved clinical outcomes regarding locoregional control (P = .042), recurrence-free survival (P = .009), overall survival (P = .017), and disease-specific death (P = .09). Advanced T stage was a significant risk factor for recurrence and death independent of HPV status.

Conclusions:

In patients with oropharyngeal carcinoma uniformly treated with chemoradiation, the presence of HPV is a favorable prognostic indicator with respect to recurrence and overall survival. However, advanced T stage was an independent risk factor for recurrence and death that can to some degree offset this benefit.

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