Predictors of overall survival in human papillomavirus-associated oropharyngeal cancer using the National Cancer Data Base

Arya Amini, Jagar Jasem, Bernard L. Jones, Tyler P. Robin, Jessica D. McDermott, Shilpa Bhatia, David Raben, Antonio Jimeno, Daniel W. Bowles, Sana D. Karam

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Objectives 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). Material and methods The NCDB was queried for patients ≥18 years 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 23.7 months (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). Conclusion 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.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalOral Oncology
Volume56
DOIs
StatePublished - May 2016
Externally publishedYes

Keywords

  • Chemoradiation
  • Head and neck squamous cell carcinoma
  • Human papillomavirus (HPV)
  • National Cancer Data Base (NCDB)
  • Oropharynx cancer
  • Survival outcomes

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

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