Prognostic Significance of Smoking in Human Papillomavirus–
            Positive
            Oropharyngeal Cancer Under American Joint Committee on Cancer Eighth Edition Stage

Purpose To determine the prognostic importance of p16 and human papillomavirus (HPV) in patients with oropharyngeal cancer treated on a phase III concurrent chemoradiotherapy trial. Patients and Methods Patients with stage III or IV head and neck squamous cell cancer were randomly assigned to concurrent radiotherapy and cisplatin with or without tirapazamine. In this substudy, analyses were restricted to patients with oropharyngeal cancer. p16 was detected by immunohistochemistry, and HPV was detected by in situ hybridization and polymerase chain reaction. Results Slides were available for p16 assay in 206 of 465 patients, of which 185 were eligible, and p16 and HPV were evaluable in 172 patients. One hundred six (57%) of 185 were p16-positive, and in patients evaluable for both p16 and HPV, 88 (86%) of 102 p16-positive patients were also HPV-positive. Patients who were p16-positive had lower T and higher N categories and better Eastern Cooperative Oncology Group (ECOG) performance status. p16-positive tumors compared with p16-negative tumors were associated with better 2-year overall survival (91% v 74%; hazard ratio [HR], 0.36; 95% CI, 0.17 to 0.74; P = .004) and failure-free survival (87% v 72%; HR, 0.39; 95% CI, 0.20 to 0.74; P = .003). p16 was a significant prognostic factor on multivariable analysis (HR, 0.45; 95% CI, 0.21 to 0.96; P = .04). p16-positive patients had lower rates of locoregional failure and deaths due to other causes. There was a trend favoring the tirapazamine arm for improved locoregional control in p16-negative patients (HR, 0.33; 95% CI, 0.09 to 1.24; P = .13). Conclusion HPV-associated oropharyngeal cancer is a distinct entity with a favorable prognosis compared with HPV-negative oropharyngeal cancer when treated with cisplatin-based chemoradiotherapy.

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Value of transoral surgery for human papillomavirus-mediated oropharyngeal cancer: validation of a new staging system in Japanese patients

Journal of International Medical Research ◽

10.1177/0300060519866594 ◽

2019 ◽

Vol 47 (10) ◽

pp. 5048-5059 ◽

Cited By ~ 1

Author(s):

Eiko Kimura ◽

Koji Araki ◽

Masayuki Tomifuji ◽

Yuya Tanaka ◽

Kosuke Uno ◽

...

Keyword(s):

Human Papillomavirus ◽

Oropharyngeal Cancer ◽

Poor Prognosis ◽

Staging System ◽

Japanese Patients ◽

Clinical Staging ◽

Transoral Surgery ◽

Seventh Edition ◽

Eighth Edition ◽

Ajcc Staging

Objective This study aimed to validate new staging of Japanese patients with human papillomavirus-mediated oropharyngeal cancer (HPV+-OPC) and the effectiveness of transoral surgery. Methods Fifty-three patients with HPV+-OPC were classified according to the seventh and eighth editions of the American Joint Committee on Cancer (AJCC) staging, along with assessment of prognosis, smoking and alcohol status, and treatment outcome. Transoral videolaryngoscopic surgery (TOVS) was performed as transoral surgery. Results The 5-year overall survival (OS) rate was 77.3% in all patients. Five-year OS rates of seventh edition staging were as follows: II, 100%; III, 100%; IVa, 75.9%; and IVb and IVc, 0%. Five-year OS rates of the eighth edition clinical staging were as follows: I, 89.3%; II, 88.9%; III, 46.3%; and IV, 0%. In non-smoking and smoking patients with HPV+-OPC, the 5-year OS rates were 90.9% and 70.7%, respectively. TOVS was used for treating 20 smokers with HPV+-OPC (5-year OS: 85.7%), while 12 were treated with chemoradiotherapy (5-year OS: 75.0%). Conclusions The eighth edition of the AJCC determines the prognosis of HPV+-OPC more accurately than the seventh edition in clinical staging. Smokers with HPV+-OPC have a poor prognosis, but TOVS might improve the prognosis.

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