Classical risk factors, but not HPV status, predict survival after chemoradiotherapy in advanced head and neck cancer patients

• Published in: Journal of cancer research and clinical oncology 2016-10, Vol.142 (10), p.2185-2196
• Main Authors: Descamps, Géraldine, Karaca, Yasemin, Lechien, Jérôme R, Kindt, Nadège, Decaestecker, Christine, Remmelink, Myriam, Larsimont, Denis, Andry, Guy, Hassid, Samantha, Rodriguez, Alexandra, Khalife, Mohammad, Journe, Fabrice, Saussez, Sven
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alcohol; Alcohol Drinking - pathology; Cancer Research; Carcinoma, Squamous Cell - etiology; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Carcinoma, Squamous Cell - virology; Chemoradiotherapy; Chemotherapy; DNA, Viral - genetics; DNA, Viral - isolation & purification; Female; Head & neck cancer; Head and Neck Neoplasms - etiology; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - therapy; Head and Neck Neoplasms - virology; Hematology; Human papillomavirus; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - virology; Oncology; Original Article – Clinical Oncology; Original – Clinical Oncology; Papillomaviridae; Papillomaviridae - genetics; Papillomaviridae - isolation & purification; Papillomavirus Infections - complications; Papillomavirus Infections - pathology; Papillomavirus Infections - virology; Paraffin Embedding; Radiation therapy; Smoking - pathology; Squamous Cell Carcinoma of Head and Neck; Tobacco; Young Adult
• ISSN: 0171-5216; 1432-1335
• DOI: 10.1007/s00432-016-2203-7

Purpose Despite the advent of concomitant chemoradiotherapy (CCRT), the prognosis of advanced head and neck squamous cell carcinoma (HNSCC) patients remains particularly poor. Classically, HNSCC, especially oropharyngeal carcinomas, associated with human papillomavirus (HPV) exhibits better treatment outcomes than HNSCCs in non-infected patients, eliciting a call for the de-escalation of current therapies. To improve the management of HNSCC patients, we aimed to determine the impact of active HPV infection on patient response, recurrence and survival after CCRT in a population of heavy tobacco and alcohol consumers. Methods Paraffin-embedded samples from 218 advanced HNSCC patients, mostly smokers and/or drinkers treated by CCRT, were tested for the presence of HPV DNA by surrogate type-specific E6/E7 qPCR and p16 immunohistochemistry. Associations between the response to CCRT and patient outcomes according to HPV status and clinical data were evaluated by Kaplan–Meier analysis and both univariate and multivariate Cox regression. Results Type-specific E6/E7 PCR demonstrated HPV positivity in 20 % of HNSCC. Regarding HPV status, we did not find any significant relation with response to therapy in terms of progression-free survival or overall survival. However, we observed a significantly worse prognosis for consumers of alcohol and tobacco compared to nondrinkers ( p  = 0.003) and non-smokers ( p  = 0.03). Survival analyses also revealed that the outcome is compromised in stage IV patients ( p  = 0.007) and, in particular, for oral cavity, hypopharynx and oropharynx carcinoma patients ( p  = 0.001). Conclusion The risk of death from HNSCC significantly increases when patients are exposed to tobacco and alcohol during their therapy, regardless of HPV status.