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The prognostic role of sex, race, and human papillomavirus in oropharyngeal and nonoropharyngeal head and neck squamous cell cancer
Author(s) -
Fakhry Carole,
Westra William H.,
Wang Steven J.,
van Zante Annemieke,
Zhang Yuehan,
Rettig Eleni,
Yin Linda X.,
Ryan William R.,
Ha Patrick K.,
Wentz Alicia,
Koch Wayne,
Richmon Jeremy D.,
Eisele David W.,
D'Souza Gypsyamber
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30353
Subject(s) - medicine , oncology , cancer , head and neck cancer , hazard ratio , stage (stratigraphy) , larynx , human papillomavirus , population , head and neck squamous cell carcinoma , gynecology , surgery , confidence interval , paleontology , environmental health , biology
BACKGROUND Human papillomavirus (HPV) is a well‐established prognostic marker for oropharyngeal squamous cell cancer (OPSCC). Because of the limited numbers of women and nonwhites in studies to date, sex and racial/ethnic differences in prognosis have not been well explored. In this study, survival differences were explored by the tumor HPV status among 1) patients with OPSCCs by sex and race and 2) patients with nonoropharyngeal (non‐OP) head and neck squamous cell cancers (HNSCCs). METHODS This retrospective, multi‐institution study included OPSCCs and non‐OP HNSCCs of the oral cavity, larynx, and nasopharynx diagnosed from 1995 to 2012. Race/ethnicity was categorized as white non‐Hispanic, black non‐Hispanic, Asian non‐Hispanic, and Hispanic of any race. Tumors were centrally tested for p16 overexpression and the presence of HPV by HPV16 DNA and high‐risk HPV E6/E7 messenger RNA in situ hybridization. Kaplan‐Meier and Cox proportional hazards models were used to evaluate overall survival (OS). RESULTS The study population included 239 patients with OPSCC and 621 patients with non‐OP HNSCC with a median follow‐up time of 3.5 years. After adjustments for the tumor HPV status, age, current tobacco use, and stage, the risk of death was lower for women versus men with OPSCC (adjusted hazard ratio, 0.55; P = .04). The results were similar with p16. In contrast, for non‐OP HNSCCs, HPV positivity, p16 positivity, and sex were not associated with OS. CONCLUSIONS For OPSCC, there are differences in survival by sex, even after the tumor HPV status has been taken into account. For non‐OP HNSCC, the HPV status and the p16 status are not of prognostic significance. Cancer 2017;123:1566–1575. © 2017 American Cancer Society .