Prognosis of HPV-Positive and -Negative Oropharyngeal Cancers Depends on the Treatment Modality

Abstract

Background: The association between human papilloma virus (HPV) and oropharyngeal carcinoma is a topical issue due mainly to the rapid increase in incidence over recent years. These tumors are etiopathogenetically, epidemiologically, and clinically diff erent from other carcinomas at this location. They have a better prognosis in that they are more chemo- and radiosensitive. Indeed, this has been shown by many extensive retrospective and prospective studies. HPV status is considered an integral part of a standard histopathological examination and is included as a new biological parameter in TNM classifi cation. Materials and methods: The results of 77 patients who were treated non-surgically for locally advanced oropharyngeal carcinoma at a single university ear, nose, and throat clinic were analyzed retrospectively. Results: Overall and specifi c survival of those with HPV-positive (HPV+) tumors was better that those for HPV negative (HPV-) tumors. With the exception of TNM classifi cation, HPV positivity appeared to be the strongest predictor of local control, and of overall and specifi c survival, regardless of the type of treatment. How ever, smoking and p53 positivity were signifi cant negative predictors of overall survival. Patients with HPV-associated tumors had a signifi cantly better prognosis, regardless of treatment type. The diff erence between treatment modalities was confi rmed for the whole group of patients, but not for the HPV+ and HPV- patients specifi cally, most probably due to the small number of patients enrolled. Conclusion: The results obtained herein may constitute the fi rst step toward the concept of treatment de-escalation in those with HPV-associated oropharyngeal carcinoma; however, this decision can be based only on the results of current extensive randomized trials. Specifi cation of the optimal de-escalation scheme, or the choice of treatment modality, for which the diff erence in treatment results is most pronounced, has yet to be identified.