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Poor prognostic factors in human papillomavirus-positive head and neck cancer: who might not be candidates for de-escalation treatment?

Cited 3 time in Web of Science Cited 5 time in Scopus
Authors
Yoo, Shin Hye; Ock, Chan-Young; Keam, Bhumsuk; Park, Sung Joon; Kim, Tae Min; Kim, Jin Ho; Jeon, Yoon Kyung; Chung, Eun-Jae; Kwon, Seong Keun; Hah, J. Hun; Kwon, Tack-Kyun; Jung, Kyeong Chun; Kim, Dong-Wan; Wu, Hong-Gyun; Sung, Myung-Whun; Heo, Dae Seog
Issue Date
2019-11
Citation
The Korean Journal of Internal Medicine, Vol.34 No.6, pp.1313-1323
Keywords
Human papillomavirusHead and neck neoplasmsOverall survivalDe-escalation
Abstract
Background/Aims: Since patients with human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) have favorable outcomes after treatment, treatment de-escalation for these patients is being actively investigated. However, not all HPV-positive HNSCCs are curable, and some patients have a poor prognosis. The purpose of this study was to identify poor prognostic factors in patients with HPV-positive HNSCC. Methods: Patients who received a diagnosis of HNSCC and tested positive for HPV from a000 to 2015 at a single hospital site (n = 152) were included in this retrospective analysis. HPV typing was conducted using the HPV DNA chip assay or liquid bead microarray system. Expression of p16 in the tumors was assessed by immunohistochemistry. To determine candidate factors associated with overall survival (OS), univariate and multivariable Cox regression analyses were performed. Results: A total of 152 patients with HPV-positive HNSCC were included in this study; 82.2% were male, 43.4% were current or former smokers, and 84.2% had oropharyngeal cancer. By univariate analysis, old age, performance status >= 1, non-oropharyngeal location, advanced T classification (T3-4), and HPV genotype 18 were significantly associated with poor OS. By multivariable analysis, performance status >= 1 and non-oropharyngeal location were independently associated with shorter OS (hazard ratio [HR], 4.36, p = 0.015; HR, 11.83, p = 0.002, respectively). Furthermore, HPV genotype 18 positivity was also an independent poor prognostic factor of OS (HR, 10.87, p < 0.001). Conclusions: Non-oropharyngeal cancer, poor performance status, and HPV genotype 18 were independent poor prognostic factors in patients with HPV-positive HNSCC. Patients with these risk factors might not be candidates for de-escalation treatment.
ISSN
1226-3303
URI
http://hdl.handle.net/10371/165211
DOI
https://doi.org/10.3904/kjim.2017.397
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College of Medicine/School of Medicine (의과대학/대학원)Cancer Research Institute (암연구소)Journal Papers (저널논문_암연구소)
College of Medicine/School of Medicine (의과대학/대학원)Internal Medicine (내과학전공)Journal Papers (저널논문_내과학전공)
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