Evaluating human papillomavirus testing, prevalence, and association with prognosis in head and neck squamous cell carcinoma by subsite: A national cancer database study

• Published in: American journal of otolaryngology 2024-05, Vol.45 (3), p.104243, Article 104243
• Main Authors: Barlow, Joshua, Gilja, Shivee, Ferrandino, Rocco M., Berger, Michael H., Posner, Marshall R., Bakst, Richard L., Khan, Mohemmed N., Teng, Marita S., Genden, Eric M., Chai, Raymond L., Roof, Scott A.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Databases, Factual; Female; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - virology; Head and neck squamous cell carcinoma; HPV-associated oropharyngeal squamous cell carcinoma; Human papillomavirus; Human Papillomavirus Viruses - isolation & purification; Humans; Male; Middle Aged; National Cancer Database; Papillomavirus Infections - diagnosis; Prevalence; Prognosis; Squamous Cell Carcinoma of Head and Neck - diagnosis; Squamous Cell Carcinoma of Head and Neck - virology; Survival Rate; United States - epidemiology
• ISSN: 0196-0709; 1532-818X; 1532-818X
• DOI: 10.1016/j.amjoto.2024.104243

To compare human papillomavirus (HPV) testing, prevalence, and association with prognosis between head and neck squamous cell carcinoma (HNSCC) subsites. This study utilized the National Cancer Database (NCDB) to identify patients diagnosed with HNSCC between 2010 and 2017. Rates of HPV testing, HPV-positivity, and changes in these rates over time were measured by subsite. The impact of HPV-positivity on overall survival across six head and neck subsites was assessed using multivariable-adjusted Cox proportional hazards analysis. A total of 121,550 patients were included. Of this cohort, 87,575 (72.1%) were tested for HPV, with the oropharynx (55,049/64,158; 85.8%) displaying the highest rates of testing and the sinonasal tract (1519/2853; 53.2%) displaying the lowest testing rates. Of the 86,136 with a definitive result, 46,878 (54.4%) were HPV-positive, with the oropharynx (40,313/54,205; 74.4%) displaying the highest rates of HPV-positivity and the oral cavity (1818/11,505; 15.8%) displaying the lowest. HPV-positive malignancy was associated with significantly improved adjusted overall survival in the oropharynx (HR = 0.42 [95% CI: 0.43–0.47]), oral cavity (HR = 0.86 [95% CI: 0.79–0.95]), sinonasal tract (HR = 0.63 [95% CI: 0.48–0.83]), larynx (HR = 0.78 [95% CI: 0.71–0.87]), and hypopharynx (HR = 0.56 [95% CI: 0.48–0.66]), but not the nasopharynx (HR = 0.93 [95% CI: 0.77–1.14]). HPV testing rates were significantly lower in non-oropharyngeal subsites. This is relevant as HPV-associated disease displayed significantly improved overall survival in both the oropharynx and four of five non-oropharyngeal subsites. While validation with prospective studies is necessary, these findings may warrant HPV testing in all HNSCC subsites.