Rates of HPV-positive tumors are increasing among patients with oropharyngeal cancer in the U.S., regardless of sex or race, according to a retrospective cohort study published in Cancer.
Additionally, gender and race are independently associated with survival in HPV-negative — but not HPV-positive — tumor status, researchers observed.
“The ability to examine sex- and race-based differences in prognosis is limited in institutional and cooperative group trials due to the small numbers of women and nonwhites, reflecting the epidemiologic and demographic characteristics of the disease entity,” Farhoud Faraji, MD, PhD, otolaryngologist in the division of otolaryngology-head and neck surgery at University of California, San Diego Health, and in the department of otolaryngology-head and neck surgery at Johns Hopkins University School of Medicine, and colleagues wrote. “The current study represents the largest analysis to date evaluating prevalence trends and prognostic differences of HPV in oropharyngeal cancer by sex and race.”
Faraji and colleagues analyzed data from the National Cancer Database on patients diagnosed with head and neck squamous cell carcinoma of the oropharynx between 2010 and 2015 who had available data on HPV status.
The study population included 28,653 patients (68%) with HPV-positive tumors and 13,371 patients (32%) with HPV-negative oropharyngeal cancer. Patients with HPV positive disease had a significantly lower mean age than those with HPV-negative disease (59.1 years vs. 61.3 years). The also were more likely to be men (85.8% vs. 76.4%) and less likely to be black (4.5% vs. 11.3%), Asian (0.8% vs. 1.3%) or Hispanic (2.8% vs. 3.8%).
Study outcomes included HPV status of the tumors and OS.
Analyses stratified by HPV tumor status showed a higher prevalence of HPV-positive tumors among men (70.6%) than women (56.3%), with significant increases at annual rates of 3.5% for men and 3.2% for women.
In an analysis by race, white patients had the highest rates of HPV-positive tumors (70.2%), followed by Hispanics (61.3%), Asian patients (55.8%) and black patients (46.3%). Black and Hispanic patients showed significantly greater increases in HPV-positive tumors annually (6.5% and 5.6%) than white patients (3.2%).
With a median follow-up of 35.7 months, the researchers observed overall 3-year OS of 77% (95% CI, 77-78) and 5-year OS of 70% (95% CI, 70-71). Patients with HPV-positive tumors had a 50% decreased risk for death compared with patients with HPV-negative tumors (adjusted HR = 0.5; 95% CI, 0.47-0.52).
Researchers observed no association between gender nor race/ethnicity and survival among patients with HPV-positive oropharyngeal cancer; however, among patients with HPV-negative disease, women had a significantly higher mortality risk than men (adjusted HR = 1.17; 95% CI, 1.08-1.26) as did black patients compared with white patients (adjusted HR = 1.21; 95% CI, 1.1-1.33).
“This analysis of a large, hospital-based national cohort with confirmed tumor HPV status found that the prevalence of HPV is increasing among male, female, white, black and Hispanic patients,” the researchers wrote. “Sex and race appear to be independently associated with survival in HPV-negative disease but not in HPV-positive disease. Our findings underscore the evolving nature of HPV-positive oropharyngeal cancer in the U.S., and the need for ongoing surveillance of epidemiologic trends.” – by Jennifer Byrne
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