Survival advantage in patients with human papillomavirus-driven oropharyngeal cancer and variation by demographic characteristics and serologic response: Findings from head and neck 5000

Alex Whitmarsh, Miranda Pring, Steve J Thomas, Andrea Waylen, Andy R Ness, Tom Dudding, Michael Pawlita, Nicole Brenner, Tim Waterboer, Lea Schroeder

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Abstract

BACKGROUND: Patients with human papillomavirus (HPV)-driven oropharyngeal cancer (OPC) experience better survival than those with HPV-negative OPC. It is unclear whether this benefit varies by demographic characteristics and serologic response.

METHODS: Records from 1411 patients with OPC who had HPV serology data were analyzed. HPV status was based on HPV type 16 (HPV16) E6 serology. Participants were followed for a median of 5.9 years, and Cox proportional hazards models were used to estimate hazard ratios (HRs). The association between HPV status and overall survival was analyzed by age group, sex, smoking status, tumor site, HPV antibody levels, and HPV antibody pattern. Models were adjusted for age, sex, smoking status, and comorbidity.

RESULTS: For the overall association between HPV status and survival, the fully adjusted HR was 0.43 (95% CI, 0.33-0.56). The HR was 0.19 (95% CI, 0.10-0.35) for participants aged ≤54 years, 0.38 (95% CI, 0.25-0.56) for those aged 55 to 64 years, and 0.73 (95% CI, 0.47-1.13) for those aged ≥65 years (P for interaction = .023). There was no clear evidence for an interaction by sex, smoking status, or tumor site. Survival did not differ according to E6 antibody levels in those who were seropositive. All seropositivity patterns were associated with increased survival compared with a pattern of seronegativity for all antibodies. Patients who are positive for E1, E2, E6, and E7 may experience better survival.

CONCLUSIONS: HPV status confers a survival advantage across all groups. This survival advantage is more marked for younger patients. The HPV antibody pattern, but not the antibody level, may also affect survival.

Original languageEnglish
Pages (from-to)2442-2452
Number of pages11
JournalCancer
Volume127
Issue number14
Early online date15 Mar 2021
DOIs
Publication statusPublished - 15 Jul 2021

Bibliographical note

Funding Information:
This publication presents data from the Head and Neck 5000 study. The study was a component of independent research funded by the National Institute for Health Research under its Programme Grants for Applied Research scheme (RP-PG-0707-10034). Core funding was also provided through awards from Above and Beyond, University Hospitals Bristol and Weston Research Capability Funding, and the National Institute for Health Research Senior Investigator award to Andy R. Ness. Human papillomavirus (HPV) serology was supported by a Cancer Research UK Program Grant, the Integrative Cancer Epidemiology Program (grant C18281/A19169).

Publisher Copyright:
© 2021 American Cancer Society

Keywords

  • cohort studies
  • Head and Neck 5000
  • human papillomavirus
  • oropharyngeal cancer
  • survival

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