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. 2016 Jan:52:97-103.
doi: 10.1016/j.oraloncology.2015.10.016. Epub 2015 Nov 14.

Understanding the impact of survival and human papillomavirus tumor status on timing of recurrence in oropharyngeal squamous cell carcinoma

Theresa Guo  1 , Eleni Rettig  1 , Carole Fakhry  2
Affiliations

Understanding the impact of survival and human papillomavirus tumor status on timing of recurrence in oropharyngeal squamous cell carcinoma

Theresa Guo et al. Oral Oncol. 2016 Jan.

Abstract

Objectives: Human papillomavirus (HPV)-positive tumor status is associated with improved prognosis after disease recurrence in oropharyngeal squamous cell carcinoma (OPSCC). In this study the potential role of survival bias in the relationship between HPV tumor status and the timing of recurrence was evaluated, given conflicting evidence in the literature.

Materials & methods: A secondary analysis was performed on a previously published retrospective two institution study of recurrent OPSCC with known HPV tumor status. Patients were categorized as "early" (surviving <24 months) or "late" survivors (⩾24 months). Timing of first recurrence and overall survival were analyzed using Kaplan-Meier and cox proportional hazard methods. Two-sided p-values <0.05 were considered significant.

Results: In total 101 patients met criteria including 81 late and 20 early survivors. HPV-positive tumor status was associated with longer time to recurrence in late survivors (median 21.8 vs. 13.8 months, p=0.028). Late survivors had later recurrences in HPV-positive (p<0.001) and HPV-negative patients (p=0.0096), as well as in both locoregional (p<0.0001) and distant metastatic recurrence (p<0.0001). In multivariate analysis, both HPV-positive tumor status (adjusted HR [aHR] 0.48, p=0.006) and survival beyond 24 months (aHR 0.21, p<0.001) were associated with later recurrence. When stratified, HPV tumor status was only associated with later recurrence in late survivors (aHR 0.47, p=0.015).

Conclusions: Late survivorship was associated with late recurrence for both HPV-positive and HPV-negative patients. Stratification by survival illustrates how survival bias links late survivorship with late recurrences and contributes to our understanding of the impact of HPV tumor status on the timing of recurrence.

Keywords: Human papillomavirus; Metastasis; Oropharynx cancer; Recurrence.

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Conflict of interest statement

Conflicts of Interest: None declared

All the authors have no financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work, and nothing to disclose.

Figures

Figure 1
Figure 1. Time to recurrence
(A) by survival group (surviving <24 months vs. >=24 months); (B) by HPV tumor status; (C) in patients surviving less than 24 months by HPV tumor status; (D) in patients surviving longer than 24 months by HPV tumor status; (E) HPV-positive patients by survival group; (F) HPV-negative patients by survival group.
Figure 2
Figure 2. Overall survival after primary diagnosis
(A) by HPV tumor status; (B) by time to recurrence (<12 months vs. >=12 months); (C) in patients recurring within 12 months by HPV tumor status; (D) in patients recurring after 12 months by HPV tumor status; (E) HPV-positive patients by time to recurrence; (F) HPV-negative patients by time to recurrence
See this image and copyright information in PMC

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