Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis

Background:The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment st...

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Published in:JMIR public health and surveillance 2023-08, Vol.9, p.e47579
Main Authors: Zhang, Dong-Dong, Lei, Min, Wang, Yue, Zeng, Pei-Ji, Hong, Yong-Jun, Cai, Cheng-Fu
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Language:English
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Alcohol use
Chemotherapy
Disease
Epidemiology
Gender
Head & neck cancer
Human papillomavirus
Infections
Medical prognosis
Metastasis
Mortality
Original Paper
Patients
Polymerase chain reaction
Population
Radiation therapy
Statistical analysis
Surgery
Surveillance
Throat cancer
Tobacco
Tumors
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description Background:The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC.Objective:We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC.Methods:We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer–specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis.Results:We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P
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The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC.Objective:We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC.Methods:We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer–specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis.Results:We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P<.001), SPCM (sHR 0.400, 95% CI 0.321-0.496; P<.001), and NCCM (sHR 0.460, 95% CI 0.378-0.560; P<.001) than those with HPV-negative disease. The 5-year risk of HNCSM was 26.9% and 10.7% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of SPCM was 12.4% and 4.6% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of NCCM of death was 13.7% and 5.8% in those with HPV-negative and HPV-positive disease, respectively (P<.001). Using the Fine and Gray competing-risks model, our results show that those with HPV-negative tumors had a significantly higher risk of HNCSM (P<.001), SPCM (P<.001), and NCCM (P<.001) than those with HPV-negative tumors.Conclusions:HPV-positive OPSCC has a lower NCSM, SPCM, and NCCM as compared to those with HPV-negative OPSCC. HPV positivity is a favorable prognostic factor in the context of overcoming cancer as well as in terms of reducing the risk of other CODs in OPSCC. Our finding supports the need to tailor patient follow-up based on the HPV status of patients with OPSCC.]]></description><identifier>ISSN: 2369-2960</identifier><identifier>EISSN: 2369-2960</identifier><identifier>DOI: 10.2196/47579</identifier><identifier>PMID: 37642982</identifier><language>eng</language><publisher>Toronto: JMIR Publications</publisher><subject>Alcohol use ; Chemotherapy ; Disease ; Epidemiology ; Gender ; Head &amp; neck cancer ; Human papillomavirus ; Infections ; Medical prognosis ; Metastasis ; Mortality ; Original Paper ; Patients ; Polymerase chain reaction ; Population ; Radiation therapy ; Statistical analysis ; Surgery ; Surveillance ; Throat cancer ; Tobacco ; Tumors</subject><ispartof>JMIR public health and surveillance, 2023-08, Vol.9, p.e47579</ispartof><rights>2023. This work is licensed under https://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Dong-Dong Zhang, Min Lei, Yue Wang, Pei-Ji Zeng, Yong-Jun Hong, Cheng-Fu Cai. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 29.08.2023.</rights><rights>Dong-Dong Zhang, Min Lei, Yue Wang, Pei-Ji Zeng, Yong-Jun Hong, Cheng-Fu Cai. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 29.08.2023. 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c435t-7d711b62e73b9c6568cfb24480a9e0bc79dd915134ef3e3822c8b1f3be2016c43</citedby><cites>FETCH-LOGICAL-c435t-7d711b62e73b9c6568cfb24480a9e0bc79dd915134ef3e3822c8b1f3be2016c43</cites><orcidid>0000-0002-7633-9209 ; 0009-0007-0065-4599 ; 0009-0009-1883-4146 ; 0009-0003-8506-3835 ; 0009-0009-0460-573X ; 0000-0002-8879-9587</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2917613092/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2917613092?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25752,27923,27924,37011,37012,44589,53790,53792,74997</link.rule.ids></links><search><creatorcontrib>Zhang, Dong-Dong</creatorcontrib><creatorcontrib>Lei, Min</creatorcontrib><creatorcontrib>Wang, Yue</creatorcontrib><creatorcontrib>Zeng, Pei-Ji</creatorcontrib><creatorcontrib>Hong, Yong-Jun</creatorcontrib><creatorcontrib>Cai, Cheng-Fu</creatorcontrib><title>Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis</title><title>JMIR public health and surveillance</title><description><![CDATA[Background:The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC.Objective:We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC.Methods:We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer–specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis.Results:We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P<.001), SPCM (sHR 0.400, 95% CI 0.321-0.496; P<.001), and NCCM (sHR 0.460, 95% CI 0.378-0.560; P<.001) than those with HPV-negative disease. The 5-year risk of HNCSM was 26.9% and 10.7% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of SPCM was 12.4% and 4.6% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of NCCM of death was 13.7% and 5.8% in those with HPV-negative and HPV-positive disease, respectively (P<.001). Using the Fine and Gray competing-risks model, our results show that those with HPV-negative tumors had a significantly higher risk of HNCSM (P<.001), SPCM (P<.001), and NCCM (P<.001) than those with HPV-negative tumors.Conclusions:HPV-positive OPSCC has a lower NCSM, SPCM, and NCCM as compared to those with HPV-negative OPSCC. HPV positivity is a favorable prognostic factor in the context of overcoming cancer as well as in terms of reducing the risk of other CODs in OPSCC. Our finding supports the need to tailor patient follow-up based on the HPV status of patients with OPSCC.]]></description><subject>Alcohol use</subject><subject>Chemotherapy</subject><subject>Disease</subject><subject>Epidemiology</subject><subject>Gender</subject><subject>Head &amp; neck cancer</subject><subject>Human papillomavirus</subject><subject>Infections</subject><subject>Medical prognosis</subject><subject>Metastasis</subject><subject>Mortality</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Polymerase chain reaction</subject><subject>Population</subject><subject>Radiation therapy</subject><subject>Statistical analysis</subject><subject>Surgery</subject><subject>Surveillance</subject><subject>Throat cancer</subject><subject>Tobacco</subject><subject>Tumors</subject><issn>2369-2960</issn><issn>2369-2960</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNpdkl1r1EAUhoMottT9DwMieLM6X5kPb6SkaguFCur1cJKc7M6SZNKZZGX_vbO7RaxXM7zn4eGcwymKFaMfOLPqo9Slti-KSy6UXXOr6Mt__hfFKqUdpZQpI4Sxr4sLoZXk1vDL4rGCJSEJHblBmLfEj-Q7zB7HOZHfPgcPMUxbiIdxg9CTCmLjxzAAqQ_kdhngiE--73O093FJ5McM85I-kSoME8Ss2iO5gRnI9Qj9Ifn0pnjVQZ9w9fReFb--fvlZ3a7vH77dVdf360aKcl7rVjNWK45a1LZRpTJNV3MpDQWLtG60bVvLSiYkdgKF4bwxNetEjTwPmh1Xxd3Z2wbYuSn6IU_hAnh3CkLcOIizb3p0qmUaas1Ua5WUiFaCkQw57yQTdYnZ9fnsmpZ6wLbJ64nQP5M-r4x-6zZh7xiV1gh27Ob9kyGGxwXT7AafGux7GDEsyXFTGmupPaFv_0N3YYl5e5myTCsmqOWZenemmhhSitj97YZRdzwKdzoK8Qc6_KcH</recordid><startdate>20230829</startdate><enddate>20230829</enddate><creator>Zhang, Dong-Dong</creator><creator>Lei, Min</creator><creator>Wang, Yue</creator><creator>Zeng, Pei-Ji</creator><creator>Hong, Yong-Jun</creator><creator>Cai, Cheng-Fu</creator><general>JMIR Publications</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-7633-9209</orcidid><orcidid>https://orcid.org/0009-0007-0065-4599</orcidid><orcidid>https://orcid.org/0009-0009-1883-4146</orcidid><orcidid>https://orcid.org/0009-0003-8506-3835</orcidid><orcidid>https://orcid.org/0009-0009-0460-573X</orcidid><orcidid>https://orcid.org/0000-0002-8879-9587</orcidid></search><sort><creationdate>20230829</creationdate><title>Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis</title><author>Zhang, Dong-Dong ; 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Medical Collection (Alumni Edition)</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>Publicly Available Content Database (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>JMIR public health and surveillance</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Dong-Dong</au><au>Lei, Min</au><au>Wang, Yue</au><au>Zeng, Pei-Ji</au><au>Hong, Yong-Jun</au><au>Cai, Cheng-Fu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis</atitle><jtitle>JMIR public health and surveillance</jtitle><date>2023-08-29</date><risdate>2023</risdate><volume>9</volume><spage>e47579</spage><pages>e47579-</pages><issn>2369-2960</issn><eissn>2369-2960</eissn><abstract><![CDATA[Background:The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC.Objective:We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC.Methods:We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer–specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis.Results:We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P<.001), SPCM (sHR 0.400, 95% CI 0.321-0.496; P<.001), and NCCM (sHR 0.460, 95% CI 0.378-0.560; P<.001) than those with HPV-negative disease. The 5-year risk of HNCSM was 26.9% and 10.7% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of SPCM was 12.4% and 4.6% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of NCCM of death was 13.7% and 5.8% in those with HPV-negative and HPV-positive disease, respectively (P<.001). Using the Fine and Gray competing-risks model, our results show that those with HPV-negative tumors had a significantly higher risk of HNCSM (P<.001), SPCM (P<.001), and NCCM (P<.001) than those with HPV-negative tumors.Conclusions:HPV-positive OPSCC has a lower NCSM, SPCM, and NCCM as compared to those with HPV-negative OPSCC. HPV positivity is a favorable prognostic factor in the context of overcoming cancer as well as in terms of reducing the risk of other CODs in OPSCC. Our finding supports the need to tailor patient follow-up based on the HPV status of patients with OPSCC.]]></abstract><cop>Toronto</cop><pub>JMIR Publications</pub><pmid>37642982</pmid><doi>10.2196/47579</doi><orcidid>https://orcid.org/0000-0002-7633-9209</orcidid><orcidid>https://orcid.org/0009-0007-0065-4599</orcidid><orcidid>https://orcid.org/0009-0009-1883-4146</orcidid><orcidid>https://orcid.org/0009-0003-8506-3835</orcidid><orcidid>https://orcid.org/0009-0009-0460-573X</orcidid><orcidid>https://orcid.org/0000-0002-8879-9587</orcidid><oa>free_for_read</oa></addata></record>
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subjects Alcohol use
Chemotherapy
Disease
Epidemiology
Gender
Head & neck cancer
Human papillomavirus
Infections
Medical prognosis
Metastasis
Mortality
Original Paper
Patients
Polymerase chain reaction
Population
Radiation therapy
Statistical analysis
Surgery
Surveillance
Throat cancer
Tobacco
Tumors
title Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis
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