Pattern of and survival following loco-regional and distant recurrence in patients with HPV+ and HPV− oropharyngeal squamous cell carcinoma: A population-based study

• Published in: Oral oncology Vol. 83; pp. 127 - 133
• Main Authors: Grønhøj, Christian, Jakobsen, Kathrine Kronberg, Jensen, David H., Rasmussen, Jacob, Andersen, Elo, Friborg, Jeppe, von Buchwald, Christian
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2018
• Subjects: Adult; Aged; Alphapapillomavirus - isolation & purification; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - virology; Failure; Female; Human papillomavirus; Humans; Male; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Oropharyngeal cancer; Oropharyngeal Neoplasms - pathology; Oropharyngeal Neoplasms - virology; Prognosis; Recurrence; Recurrence; Human papillomavirus; Oropharyngeal cancer; Failure
• ISSN: 1368-8375; 1879-0593
• DOI: 10.1016/j.oraloncology.2018.06.012

•HPV-negative patients experienced recurrence more often than HPV-positive patient.•Distant recurrence occurred predominantly to the lung, irrespective of HPV-status.•HPV-status is an independent and strong predictor of recurrence. The incidence of human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing. Currently, data is sparse on the pattern and timing of recurrence. This long-term study concerning both HPV- and p16-status aimed to report predictive factors, pattern, timing of loco-regional recurrence (LRR) and distant recurrence (DR), and survival following recurrence in patients diagnosed with OPSCC. We included patients diagnosed with OPSCC from 2000 to 2014 in Eastern Denmark, who were treated with curative intent. Tumors were defined as HPV-positive when they were both HPV-DNA and p16-positive. Time-to-failure and -death were estimated by the Kaplan-Meier method. Cox proportional hazards models were used to evaluate predictors of failure. The cohort consisted of 1244 consecutive patients with OPSCC of which 288 patients (23%) experienced recurrence. Of these patients, the majority (n = 197/1244; 16%) experienced LRR and the remaining (n = 91/1244; 7%) DR. Significantly more HPV-negative patients experienced recurrence (n = 170/486; 35%) compared to HPV-positive patient (n = 112/726; 15%). DR occurred for both groups predominantly to the lung (n = 63/91; 69.2%) followed by the liver and bone. Factors influencing risk of LRR included gender, T-classification, and HPV-status. The same variables influenced risk of DR in addition to the UICC-8 classification, N-classification, pack years of smoking, and performance status. HPV-status was the strongest risk factor for LRR and DR. LRR and DR occur significantly less often in HPV-positive patients compared with HPV-negative patients. HPV-status is an independent and strong predictor of recurrence. DR most commonly occurs to the lungs, irrespective of HPV-status.