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Improved outcomes in HNSCC may be due to HPV incidence
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Survival for patients with oropharyngeal head and neck squamous cell cancer improved significantly between 1993 and 2010, according to study results.
However, outcomes for patients with non-oropharyngeal head and neck squamous cell cancer (HNSCC) only trended toward improvement during that period, results showed.
HPV represents a positive prognostic factor for oropharyngeal HNSCC.
Consequently, Lauren C. Das, MD, of the department of radiation and cellular oncology at the University of Chicago Medical Center, and colleagues conducted the study to determine whether the increased incidence of HPV or advances in treatment have driven the improvements in HNSCC outcomes reported in non-randomized clinical trials.
Das and colleagues evaluated data on 422 patients with oropharyngeal (55.7%) and non- oropharyngeal (44.3%) locoregionally advanced HNSCC included in prospective institutional trials at a single institution. All patients had undergone treatment with chemotherapy and radiation.
Researchers grouped patients into one of three categories according to treatment time period: 1993 to 1998 (group 1), 1999 to 2003 (group 2), and 2004 to 2010 (group 3).
Among patients with oropharyngeal HNSCC, 5-year OS rates increased from 42.3% in group 1, to 72.5% in group 2, to 78.4% in group 3 (adjusted P=.0084). Among patients with non-oropharyngeal HNSCC, 5-year OS rates improved from 51% in group 1, to 58.8% in group 2, to 66.3% in group 3 (adjusted P=.51).
Researchers observed a significant improvement in 5-year RFS rates for those with oropharyngeal HNSCC (42.3% for group 1; 68.4% for group 2; and 75.8% for group 3; adjusted P=.017) but not for those with non-oropharyngeal HNSCC (42.9% for group 1; 53.6% for group 2; and 61.7% for group 3; adjusted P=.3).
Five-year rates of distant failure-free survival also increased significantly among those with oropharyngeal HNSCC (42.3% for group 1; 71.1% for group 2; and 77.8% for group 3; adjusted P=.011) but not for those with non-oropharyngeal HNSCC (46.9% for group 1; 57.1% for group 2; and 66% for group 3; adjusted P=.38).
“Although our patients are not stratified by HPV status, improving oropharyngeal outcomes are likely at least partly due to the increasing HPV incidence,” Das and colleagues wrote. “These data further justify trial stratification by HPV status, investigations of novel approaches for carcinogen-related HNSCC and current de-intensification for HPV-related HNSCC.”
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