Immunologic mediators of outcome for irradiated oropharyngeal carcinoma based on human papillomavirus status

• Published in: Oral oncology 2019-02, Vol.89, p.121-126
• Main Authors: Meshman, Jessica, Velez, Maria A., Wang, Pin-Chieh, Abemayor, Elliot, St. John, Maie, Wong, Deborah, Bhuta, Sunita, Chen, Allen M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Female; HPV; Humans; Immunologic; Lymphocyte; Male; Middle Aged; Oropharyngeal Neoplasms - immunology; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - radiotherapy; Oropharynx; Papillomaviridae - pathogenicity; Prognosis; Radiation; Young Adult
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2018.11.030

•Low lymphocytes predicted for recurrence for HPV-positive oropharyngeal carcinoma.•Immune status is influential in HPV-positive but not HPV-negative oropharyngeal carcinoma.•These findings may have implications with respect to the design of future clinical trials. To investigate the prognostic value of pre-treatment immune parameters including white blood cell count (WBC) and circulating lymphocyte count (CLC) among patients with oropharyngeal carcinoma treated by radiation therapy. A total of 136 consecutive patients were treated by radiation therapy for locally advanced (stage III/IV) squamous cell carcinoma of the oropharynx with known human papillomavirus (HPV) status. Medical records were reviewed to identify patients with documented pre-treatment laboratory bloodwork. The Kaplan-Meier method and linear regression models were used to evaluate the association between pre-treatment CBC and CLC values with survival endpoints. One hundred and eleven patients satisfied inclusion criteria. Median age was 62 years (range, 22–91). Eighty-four patients were HPV-positive (76%) and 27 (24%) were HPV-negative. There was no difference in WBC and CLC mean values at baseline between HPV-positive and HV-negative (p > 0.05, for both). Trends were detected in the HPV-positive cohort favoring patients with higher CLC, with respect to 2-year local-regional control (93% vs. 82%, p = 0.06) and distant control (88% vs. 82%, p = 0.10) using the median CLC as cut-off. HPV-positive patients with CLC values in the lowest quartile had inferior local-regional control compared to those in the upper 3 quartiles (69% vs. 89%, p = 0.01). Low pre-treatment CLC was correlated with local-regional recurrence and distant failure among HPV-positive patients. These associations were not observed in the HPV-negative cohort.