Long-term prognosis and risk factors among patients with HPV-associated oropharyngeal squamous cell carcinoma

Brian M. Lin, Hao Wang, Gypsyamber D'Souza, Zhe Zhang, Carole Fakhry, Andrew W. Joseph, Virginia E. Drake, Giuseppe Sanguineti, William H. Westra, Sara I. Pai

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57 Scopus citations


BACKGROUND A subset of patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (HPV-OSCC) experience poor clinical outcomes. The authors of this report explored prognostic risk factors for overall survival (OS) and recurrence-free survival (RFS). METHODS Patients with incident HPV-OSCC who received treatment at the Johns Hopkins Hospital between 1997 and 2008 and who had tissue available for HPV testing as well as demographic and clinicopathologic information (N = 176) were included. Tissue was tested for HPV by in situ hybridization (ISH) and/or p16 immunohistochemistry. Demographic and clinicopathologic information was extracted from medical records. RESULTS In total, 157 of 176 patients (90%) with OSCC had HPV-associated disease (HPV-OSCC). In the patients with HPV-OSCC, the 3-year and 5-year OS rates were 93% (95% confidence interval [CI], 88%-98%) and 89% (95% CI, 81%-97%), respectively. Shorter survival was observed among older patients (hazard ratio [HR], 2.33 per 10-year increase; 95% CI, 1.05-5.16 per 10-year increase; P =.038), patients with advanced clinical T classification (HR, 5.78; 95% CI, 1.60-20.8; P =.007), and patients who were currently using tobacco (HR, 4.38; 95% CI, 1.07-18.0; P =.04). Disease recurrence was associated with advanced clinical T-classification (HR, 8.32; 95% CI, 3.06-23; P <.0001), current/former alcohol use (HR, 13; 95% CI, 1.33-120; P =.03), and unmarried status (HR, 3.28; 95% CI, 1.20-9.00; P =.02). Patients who remained recurrence free for 5 years had an 8.6% chance of recurrence by 10 years (1-sided 95% CI upper bound, 19%; P =.088). CONCLUSIONS In this study, prognostic risk factors were identified for patients with HPV-OSCC. The observed recurrence rates between 5 years and 10 years after definitive therapy need to be validated in additional studies to determine whether extended cancer surveillance is warranted in this cancer population. Cancer 2013;119:3462-3471. © 2013 American Cancer Society. Poor prognostic risk factors for patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma include older patient age, advanced clinical tumor classification, unmarried status, and current tobacco or current/former alcohol use. In this study, a recurrence rate of 8.6% at 5 years is observed after definitive therapy, suggesting that extended cancer surveillance may be warranted for this unique patient population.

Original languageEnglish (US)
Pages (from-to)3462-3471
Number of pages10
Issue number19
StatePublished - Oct 1 2013


  • head and neck cancer
  • human papillomavirus
  • oropharyngeal cancer
  • risk factors
  • sex

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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