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

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

Juncheng Wang  1 , Yuxi Tian  2 , Huimei Huang  3 , Donghai Huang  4 , Yong Liu  4 , Yongquan Tian  4 , Gangcai Zhu  5 , Xin Zhang  6 , Robert L Ferris  7
Affiliations

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

Juncheng Wang et al. Oral Oncol. 2022 Feb.

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.

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Figures

Fig. 1.
Fig. 1.
Kaplan-Meier of OS and DSS for metastatic head and neck cancer of pharynx patients. (A) OS based on HPV status in mHNSC-P patients. (B) DSS based on HPV status in mHNSC-P patients. aHR means Hazard ratio of HPV-positive vs. HPV-negative patients by adjusting for age, race, gender, grade, T stage, N stage and treatment. 95 %CI means the range of estimates with 95% confidence intervals.
Fig. 2.
Fig. 2.
Kaplan-Meier of OS and DSS for mHNSC-OP and mHNSC-non-OP patients. (A-B) OS and DSS for metastatic oropharyngeal cancer patients by HPV status. (C-D) OS and DSS for metastatic nasopharyngeal cancer patients by HPV status. (E-F) OS and DSS for metastatic hypopharyngeal cancer patients by HPV status. aHR means Hazard ratio of HPV-positive vs. HPV-negative patients by adjusting for age, race, gender, grade, T stage, N stage and treatment. 95 %CI means the range of estimates with 95% confidence intervals.
Fig. 3.
Fig. 3.
Kaplan-Meier of OS and DSS for mHNSC-OP patients with different numbers of distant metastatic sites. (A-B) OS and DSS for oligometastatic (only metastases in 1 site) mHNSC-OP patients by HPV status. (C-D) OS and DSS for ploymetastatic (>=2 sites) mHNSC-OP patients by HPV status. aHR means Hazard ratio of HPV-positive vs. HPV-negative patients by adjusting for age, race, gender, grade, T stage, N stage and treatment. 95 %CI means the range of estimates with 95% confidence intervals.
Fig. 4.
Fig. 4.
Kaplan-Meier of DSS for mHNSC-OP patients with lung or bone metastasis only. (A) DSS for HPV associated oligometastatic (only metastases in 1 site) mHNSC-OP patients with lung metastasis only. (B) DSS for HPV associated oligometastatic (only metastases in 1 site) mHNSC-OP patients with bone metastasis only. aHR means Hazard ratio of HPV-positive vs. HPV-negative patients by adjusting for age, race, gender, grade, T stage, N stage and treatment. 95 %CI means the range of estimates with 95% confidence intervals.
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