This article is more than 5 years old. Information may no longer be current.
Blood, saliva testing may predict recurrence of HPV-related head and neck cancers
Click Here to Manage Email Alerts
Testing for HPV-16 DNA in saliva and plasma may be a useful predictor of recurrence in patients with oropharyngeal squamous cell carcinoma, according to study results.
“There is a window of opportunity in the year after initial therapy to take an aggressive approach to spotting recurrences and intensively addressing them while they are still highly treatable,” researcher Joseph Califano, MD, of Johns Hopkins Kimmel Cancer Center, said in a press release. “Until now, there has been no reliable biological way to identify which patients are at higher risk for recurrence, so these tests should greatly help do so.”
Joseph Califano
Califano and colleagues evaluated 93 patients with oropharyngeal squamous cell carcinoma (OSCC) or squamous cell carcinoma (SCC) of undetermined etiology. All patients underwent surgery, radiation or both.
The researchers used quantitative polymerase chain reaction (PCR) to test pre- and post-treatment blood and/or saliva samples from all participants.
During median follow-up of 49 months, 19 patients (20%) developed post-treatment recurrence; of them, 14 had HPV-16–positive tumors and five had HPV-16–negative tumors.
The researchers determined the measurement of HPV-16 DNA status through pre-treatment saliva and plasma yielded a sensitivity of 76%, a specificity of 100%, a negative predictive value of 42%, and positive predictive value of 100%.
The sensitivity of pretreatment saliva testing alone was 52.8% and the sensitivity of pretreatment plasma testing alone was 67.3%.
Results of multivariate analysis showed post-treatment HPV-positive status measured by saliva was significantly associated with increased risk for recurrence (HR=10.7, 95% CI=2.36-48.5). Researchers observed a significant association between shorter OS and patients with post-treatment HPV-positive saliva samples alone (HR=25.9; 95% CI=3.23-208), as well as those with either HPV-positive saliva or plasma (HR=21.2; 95% CI, 1.85-242). However, researchers did not observe a significant association between OS and post-treatment HPV-positive plasma alone (HR=3.33; 95% CI, .03-37).
Overall, the combined post-treatment assessment of HPV-16 DNA status in saliva and plasma demonstrated a 90.7% specificity and 69.5% sensitivity for predicting recurrence within 3 years.
“When combining saliva HPV DNA status with plasma HPV DNA status, patients with HPV-positive status in either source had significantly worse [recurrence-free survival] and OS,” Califano and colleagues wrote. “Thus, quantitative PCR detection of HPV DNA in post-treatment surveillance saliva and plasma samples can function as a valuable prognostic biomarker of RFS and OS in patients with HPV-positive OPSCC.”
Disclosure: The researchers report no relevant disclosures.
Perspective
Back to TopBarbara Burtness, MD
Persistence of Epstein-Barr virus (EBV) DNA has been linked to poorer prognosis in EBV-related nasopharynx cancer. The question now arises whether detection of HPV DNA in the post-treatment setting augurs disease recurrence. Ahn and colleagues assembled a set of patients, predominantly with HPV-positive oropharynx cancers, to examine whether HPV DNA could be detected in post-treatment plasma or saliva, and what the significance of this was.
The results are interesting, but the sample size is so small that these should be viewed as exploratory data only. HPV DNA in post-treatment saliva or plasma was associated with significantly higher risks of recurrence and death, but only six patients had HPV DNA detected in a post-treatment specimen, and multivariate analysis did not adjust for T stage. Additionally, post-treatment HPV was detected in a patient with HPV-negative tumor and no detectable HPV DNA in the pre-treatment saliva and plasma, indicating the risk that intercurrent infection or reactivation of viral infection during treatment may confound the use of this as a potential surveillance tool.
Click Here to Manage Email Alerts