The prognosis of HPV-associated metastatic pharyngeal patients by primary and distant site

Juncheng Wang; Yuxi Tian; Huimei Huang; Donghai Huang; Yong Liu; Yongquan Tian; Gangcai Zhu; Xin Zhang; Robert L Ferris

doi:10.1016/j.oraloncology.2021.105675

The prognosis of HPV-associated metastatic pharyngeal patients by primary and distant site

Oral Oncol. 2022 Feb:125:105675. doi: 10.1016/j.oraloncology.2021.105675. Epub 2021 Dec 27.

Authors

Juncheng Wang¹, Yuxi Tian², Huimei Huang³, Donghai Huang⁴, Yong Liu⁴, Yongquan Tian⁴, Gangcai Zhu⁵, Xin Zhang⁶, Robert L Ferris⁷

Affiliations

¹ Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, People's Republic of China; UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA.
² UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA; Department of Geriatrics, Respiratory Medicine, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, People's Republic of China.
³ Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha 410011, Hunan, People's Republic of China.
⁴ Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, People's Republic of China.
⁵ Department of Otolaryngology Head and Neck Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha 410011, Hunan, People's Republic of China. Electronic address: qianhudoctor@csu.edu.cn.
⁶ Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha 410008, Hunan, People's Republic of China. Electronic address: xinzhang@csu.edu.cn.
⁷ UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA 15232, USA.

PMID: 34968864
DOI: 10.1016/j.oraloncology.2021.105675

Abstract

Objectives: Human papillomavirus (HPV) positivity is a favorable prognostic factor in the general population of head and neck squamous cell carcinoma (HNSCC) patients. However, its impact on the survival of metastatic HNSCC of pharynx (mHNSC-P) patients is unclear. This study aims to investigate the associations between HPV status and survival in mHNSC-P patients.

Methods: 735 mHNSC-P patients diagnosed at first presentation from 2010 to 2016 were retrieved from the Surveillance, Epidemiology and End Result database (SEER). Chi-Squared test, univariate and multivariate cox proportional hazards model, Kaplan-Meier analysis, and log-rank test were applied to compare HPV-positive and -negative mHNSC-P patients.

Result: Using univariate cox proportional hazards analysis, HPV status, primary site, T stage, treatment and distant metastatic site correlate with the overall survival (OS) and disease-specific survival (DSS) in mHNSC-P patients. Multivariate cox regression analysis shows that HPV-positive mHNSC-P patients experienced significantly better OS (HR: 0.62 CI: 0.51-0.76, p < 0.001) and DSS (HR: 0.73 CI: 0.58-0.91, p < 0.01) as compared to HPV-negative mHNSC-P patients. Subgroup analysis indicates that HPV-associated OS and DSS benefits exist in patients with metastatic HNSCC of oropharynx (mHNSC-OP) but not in patients with metastatic HNSCC of non-oropharynx (mHNSC-non-OP). Among mHNSC-OP patients, HPV positivity confers disease-specific survival benefit in patients with oligometastatic rather than polymetastatic patients. Furthermore, HPV associated OS and DSS advantages in mHNSC-OP with lung metastasis was observed.

Conclusion: HPV-positive mHNSC-OP patients with lung metastasis show better survival than HPV-negative mHNSC-OP patients, providing key information to guide patient treatment approaches.

Keywords: Bone metastasis; Disease-specific survival, metastatic head and neck squamous cell carcinoma of pharynx; Human papillomavirus associated head and neck squamous cell carcinoma; Lung metastasis; Non-oropharyngeal pharyngeal squamous cell carcinoma; Oropharyngeal squamous cell carcinoma; Overall survival; The Surveillance, Epidemiology and End Result database.

MeSH terms

Carcinoma, Squamous Cell* / pathology
Head and Neck Neoplasms* / complications
Humans
Lung Neoplasms*
Oropharyngeal Neoplasms*
Papillomavirus Infections*
Pharynx / pathology
Prognosis
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck / complications