Human Papillomavirus Outcomes in an Access-to-Care Laryngeal Cancer Cohort

• Published in: Otolaryngology-head and neck surgery 2012-05, Vol.146 (5), p.730-738
• Main Authors: Stephen, Josena K., Chen, Kang Mei, Shah, Veena, Havard, Shaleta, Lu, Mei, Schweitzer, Vanessa P., Gardner, Glendon, Worsham, Maria J.
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Squamous Cell - virology; Chi-Square Distribution; Female; gender; HPV; Human papillomavirus 16 - isolation & purification; Humans; insurance; Laryngeal Neoplasms - virology; laryngeal squamous cell cancer; Male; Michigan - epidemiology; Middle Aged; Papillomavirus Infections - complications; Papillomavirus Infections - epidemiology; Papillomavirus Infections - ethnology; Prevalence; Prognosis; race; Real-Time Polymerase Chain Reaction; Retrospective Studies; Risk Factors; Sex Factors; stage; survival outcomes; Survival Rate
• ISSN: 0194-5998; 1097-6817
• DOI: 10.1177/0194599811434482

Objective. Human papillomavirus (HPV), particularly HPV16, is a causative agent for 25% of head and neck squamous cell cancer, including laryngeal squamous cell cancer (LSCC). HPV-positive (HPV+ve) patients, particularly those with oropharyngeal SCC, have improved prognosis. For LSCC patients, this remains to be established. The goal was to determine stage and survival outcomes in LSCC in the context of HPV infection. Study Design. Historical cohort study. Setting. Primary care academic health system. Subjects and Methods. In 79 patients with primary LSCC, HPV was determined using real-time quantitative polymerase chain reaction. χ2 or Fisher exact test was used to test the association of HPV+ve with 21 risk factors including race, stage, gender, age, smoking, alcohol, treatment, and health insurance. Kaplan-Meier and log-rank tests were used to study the association of HPV and LSCC survival outcome. Results. HPV16 was detected in 27% of LSCC patients. Caucasian American (CA) patients had higher HPV prevalence (33%) than did African American (AA) LSCC patients (16%; P = .058). HPV was significantly associated with gender (P = .016) and insurance type (P = .001). There were no differences in survival between HPV+ve and HPV-negative (HPV-ve) patients. There was no association with HPV and other risk factors including stage (early vs late). Conclusion. We found a high prevalence of HPV in men and a lower prevalence of HPV infection in AA compared with CA. Despite the strikingly better survival of patients with HPV+ve oropharyngeal tumors, even when adjusted for smoking, this correlation does not seem to hold true in the larynx. Larger multiethnic LSCC cohorts are needed to more clearly delineate HPV-related survival across ethnicities.