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. 2022 Aug 1;128(15):2908-2921.
doi: 10.1002/cncr.34266. Epub 2022 May 19.

Clinical presentation and outcome of human papillomavirus-positive nasopharyngeal carcinoma in a North American cohort

Shao Hui Huang  1   2 , J C Kennetth Jacinto  1 , Brian O'Sullivan  1   2 , Jie Su  3 , John Kim  1 , Jolie Ringash  1   2 , Anna Spreafico  4 , Eugene Yu  5 , Bayardo Perez-Ordonez  6 , Ilan Weinreb  6 , John Cho  1 , Andrew J Hope  1 , Scott V Bratman  1 , Meredith E Giuliani  1 , Ali Hosni  1 , Ezra Hahn  1 , David P Goldstein  2 , Li Tong  1 , Lawson Eng  4 , Wei Xu  3 , John N Waldron  1   2
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Free article

Clinical presentation and outcome of human papillomavirus-positive nasopharyngeal carcinoma in a North American cohort

Shao Hui Huang et al. Cancer. .
Free article

Abstract

Background: The objective of this study was to describe the clinical presentation and outcomes of human papillomavirus (HPV)-positive nasopharyngeal cancer (NPC) versus Epstein-Barr virus (EBV)-positive NPC and HPV-positive oropharyngeal cancer (OPC).

Methods: Clinical characteristics and presenting signs/symptoms were compared between patients who had viral-related NPC versus viral-related OPC treated with intensity-modulated radiotherapy from 2005 to 2020 and who were matched 1:1 (by tumor and lymph node categories, smoking, age, sex, histology, and year of diagnosis). Locoregional control (LRC), distant control (DC), and overall survival (OS) were compared using the 2005-2018 cohort to maintain 2 years of minimum follow-up. Multivariable analysis was used to evaluate the cohort effect.

Results: Similar to HPV-positive OPC (n = 1531), HPV-positive NPC (n = 29) occurred mostly in White patients compared with EBV-positive NPC (n = 422; 86% vs. 15%; p < .001). Primary tumor volumes were larger in HPV-positive NPC versus EBV-positive NPC (median volume, 51 vs. 23 cm3 ; p = .002), with marginally more Level IB nodal involvement. More patients with HPV-positive NPC complained of local pain (38% vs. 3%; p = .002). The median follow-up for the 2005-2018 cohort was 5.3 years. Patients who had HPV-positive NPC (n = 20) had rates of 3-year LRC (95% vs. 90%; p = .360), DC (75% vs. 87%; p = .188), and OS (84% vs. 89%; p = .311) similar to the rates in those who had EBV-positive NPC (n = 374). Patients who had HPV-positive NPC also had rates of LRC (95% vs. 94%; p = .709) and OS (84% vs. 87%; p = .440) similar to the rates in those who had HPV-positive OPC (n = 1287). The DC rate was lower in patients who had HPV-positive disease (75% vs. 90%; p = .046), but the difference became nonsignificant (p = .220) when the analysis was adjusted for tumor and lymph node categories, smoking, and chemotherapy.

Conclusions: HPV-positive NPC and EBV-positive NPC seem to be mutually exclusive diseases. Patients who have HPV-positive NPC have greater local symptom burden and larger primary tumors but have similar outcomes compared with patients who have EBV-positive NPC or HPV-positive OPC.

Keywords: Epstein-Barr virus; clinical presentation; human papillomavirus; nasopharyngeal carcinoma; oropharyngeal carcinoma; outcomes; signs and symptoms.

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References

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