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

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.