Population-based evidence of increased survival in human papillomavirus-related head and neck cancer

Abstract

BackgroundEvidence from clinical, population-based and molecular studies has shown that human papillomavirus (HPV) infection can be a causal risk factor for a subset of head and neck squamous cell carcinomas (HNSCC). It is proposed that HPV-associated oropharyngeal cancer is a new disease entity that requires treatment and prevention strategies distinct from present recommendations. MethodsIn our population-based study we estimated incidence and survival trends in 8270 patients with HPV-related HNSCC (HPV+HNSCC) and HPV-unrelated HNSCC (HPV–HNSCC) in Norway over the past three decades. ResultsIn the period 1981–1995, patients with HPV+HNSCC had poorer survival than HPV–HNSCC (adjusted hazard ratio (HR) 1.3, 95% confidence interval (CI): 1.14–1.44). By 1996–2007, survival had increased in both groups, but the increase was significantly greater among HPV+HNSCC patients (HR 0.57, 95% CI: 0.48–0.67). During the same period, incidence also increased, but only for HPV+HNSCCs. From 1981–1995 to 1996–2007, median age at diagnosis for HPV+HNSCC decreased from 63.2 to 59.8years, while for HPV–HNSCC median age at diagnosis of 66.6years remained unchanged. ConclusionsWe demonstrate a population level improvement in survival among patients with oropharyngeal squamous cell cancers commonly related to infection with HPV. In contrast, patients with HNSCC not related to HPV only showed a modest improvement in survival in the period 1981–2007. A concomitant increase in incidence and survival was observed for HPV-related cancers only. This trend cannot be explained by changes in treatment, cancer registration nor screening, but is most likely due to an increased prevalence of HPV-positive tumours.