Abstract 3200: HPV status influences the survival of HNSCC patients: A consideration for the TNM staging system

Abstract Objective: Head and neck cancers are a heterogeneous group of malignancies, affecting various sites with differing prognoses. Accurate and reliable stratification of head and neck squamous cell carcinomas (HNSCC) for prediction of outcomes continues to be very challenging. The TNM staging system for HNSCCs is an important tool for reporting and defining treatment. However, there is increasing evidence for the role of human papillomavirus type 16 (HPV) in the pathogenesis of oropharyngeal SCC and predictive of a better prognoses. We have shown that Puerto Ricans have a high percentage of HPV-positive HNSCC particularly in the larynx. The goal of this study is to evaluate the relevance of HPV-positivity in the prediction of HNSCC patient's outcome together with the TNM staging system. Methods: Patients presenting to our department with HNSCC until 2005 and whose treatment was surgical were in included in this study. Survival trends (Kaplan-Meier survival curves) were used to evaluate survival differences according to anatomic subsite, HPV status, risk factors and clinicopathological characteristics. Results: One hundred eight -four patients were included in the study with a median follow-up of 59 months. Distribution according to specific tumor sites was 86 (46.7%) in the larynx; 70 (38%) in the oral cavity, 16 (8.7%) in the oropharynx, and 12 (6.5%) in the hypopharynx. The highest incidence of HPV – positive was in the oropharynx (67%). Multivariate analysis showed that HPV had an independent prognostic effect on the overall survival after adjusting other confounding factors such as histological grade, TNM stage and tobacco usage. The patient of HPV-positive laryngeal SCC showed a statistically longer absolute (p<0.05) and relapse-free (p=0.001) 5-year survival time than the HPV-negative group. However, the difference between HPV- positive and HPV-negative oral cavity tumors was less prominent. Patients younger than 30 years of age presented with advanced tumor stages. Failure pattern in younger age SCC patient may be attributable to biologic behavior. Conclusion: HPV status on HNSCC patients is a determinant factor in the survival of such patients dependent on tumor site and should be considered in addition to the actual TNM staging system. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3200. doi:10.1158/1538-7445.AM2011-3200