Abstract
BackgroundHPV-16–positive HNSCC and HPV-16–negative HNSCC have different clinical factors, representing distinct forms of cancers. The study aimed to identify patient-specific factors for HPV-16-positive HNSCC based on baseline clinical data.MethodFactors associated with HPV-16-positive HNSCC were identified using the data from 210 patients diagnosed with HNSCC at University College of London Hospital between January 1, 2003, and April 30, 2015, inclusive. A series of models were developed using logistic regression methods, and the overall model fit was compared using Akaike Information Criterion. Survival analysis was carried with Cox proportional hazards model for survival-time outcomes. The survival time for individual patients was defined as the time from diagnosis of HNSCC to the date of death from any cause. For patients who did not die, they were censored at the end of study on April 30, 2015.ResultsOf the 210 patients, 151 (72%) were found to have HPV-16-positive HNSCC. The logistic regression model showed that the prevalence of developing HPV-16-positive HNSCC was 3.79 times higher in patients with Type 2 Diabetes Mellitus (T2DM) (odd ratio [OR], 3.79; 95% CI, 1.70–8.44) than in those without T2DM, and 8.84 times higher in patients with history of primary HNSCC (OR, 8.84; 95% CI, 2.30–33.88) than in those without a history of primary HNSCC. HPV-16–positive HNSCC was also observed more in tonsils (OR, 4.02; 95% CL, 1.56–10.36) and less in non-alcohol drinker’s oral cavity (OR, 0.14; 95% CI, 0.03–0.56). Furthermore, individual patients were followed-up for 1 to 13 years (median of 1 year). Patients with HPV-positive HNSCC had a median survival of 5 years (95% CI, 2.6–7.3 years). Among HPV-16–positive HNSCC cohort, T2DM was a risk for poorer prognosis (hazard ratio, 2.57; 95% Cl, 1.09–6.07), and had lower median survival of 3 years (95% CI, 1.8–4.1 years), as compared to 6 years (95% CI, 2.8–9.1 years) in non-T2DM.ConclusionsPatient-specific factors for HPV-positive HNSCC are T2DM, history of primary HNSCC and tonsillar site. T2DM is associated with poorer prognosis. These findings suggest that it might be beneficial if routine HPV-16 screening is carried out in T2DM patients which can provide better therapeutic and management strategies.
Highlights
Over the past 3 decades, an increase in the incidence of human papillomavirus (HPV)-positive head and neck cancer (HNSCC), oropharyngeal cancer, has been observed in the United Kingdom, most notably among men under the age of 60 [1]
The logistic regression model showed that the prevalence of developing HPV-16-positive head and neck squamous cell carcinoma (HNSCC) was 3.79 times higher in patients with Type 2 Diabetes Mellitus (T2DM) than in those without type 2 diabetes mellitus (T2DM), and 8.84 times higher in patients with history of primary HNSCC (OR, 8.84; 95% CI, 2.30–33.88) than in those without a history of primary HNSCC
HPV-16–positive HNSCC was observed more in tonsils
Summary
Over the past 3 decades, an increase in the incidence of human papillomavirus (HPV)-positive head and neck cancer (HNSCC), oropharyngeal cancer, has been observed in the United Kingdom, most notably among men under the age of 60 [1]. Few studies developed risk predictive models of tumor HPV-16–status using tumor biomarkers [2] or histopathological features [4]. Currently there are no accepted predictive models to identify patient specific factors of HPV-16–positive HNSCC based on baseline demographic and clinical data. This may lead physicians to make ad hoc decisions about which patients to receive routine HPV-16 screening, and risk delay in testing those who are at risk of HPV-16–positive HNSCC development. We developed a methodology to identify patient-specific factors for HPV-16–positive HNSCC based on baseline clinical and medical history data. The study aimed to identify patient-specific factors for HPV-16-positive HNSCC based on baseline clinical data
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