HPV status in unknown primary head and neck cancer: Prognosis and treatment outcomes

Laryngoscope - Tập 129 Số 3 - Trang 684-691 - 2019
Shayan Cheraghlou1, Sina J. Torabi1, Zain Husain2,3, Michael Otremba1, Heather Edwards4,1, Saral Mehra1,3, Wendell G. Yarbrough5,1,3, Barbara Burtness4,3, Benjamin L. Judson1,3
1Division of Otolaryngology, Department of Surgery, New Haven, Connecticut, U.S.A
2Department of Therapeutic Radiology, New Haven, Connecticut, U.S.A
3Yale Cancer Center, New Haven, Connecticut, U.S.A
4Department of Medicine, Yale School of Medicine, New Haven, Connecticut, U.S.A
5Department of Pathology, New Haven, Connecticut, U.S.A

Tóm tắt

ObjectivesApproximately 3% to 9% of head and neck cancer presents with a metastatic node and no identifiable primary tumor. These cases of head and neck carcinoma of unknown primary (HNCUP) present a therapeutic challenge. Therapy of this disease varies based on factors such as institutional, surgeon, and patient preference. Evidence demonstrating the outcomes associated with these therapies for HNCUP is limited, and among the available series, the tumor human papillomavirus (HPV) status is often ignored. Treatment deintensification has been proposed for a subset of these patients. We aim to evaluate the treatment‐related outcomes for HPV‐associated and HPV‐negative HNCUP.MethodsA retrospective study of 978 adult HNCUP diagnosed from 2010 to 2013 in the NCDB was conducted. Multivariate Cox survival regressions as well as univariate Kaplan‐Meier analyses were conducted.ResultsPatients with HPV‐associated disease had superior survival, with a 3‐year survival of 94.8% (standard error [SE]: 1.0), compared with 80.3% (SE: 2.9) among those with HPV‐negative disease. Among HPV‐negative patients with clinical nodal classification (cN)2/cN3 disease, treatment with definitive radiotherapy alone compared to definitive chemoradiotherapy was associated with diminished survival (hazard ratio 5.507, P = 0.005). Among patients with HPV‐associated cancer and cN2/cN3 disease, all treatments (surgery alone, surgery with adjuvant radiotherapy, surgery with adjuvant chemoradiotherapy, definitive chemoradiotherapy, definitive radiotherapy) resulted in statistically equivalent survival.ConclusionTumor HPV status has a significant prognostic value for HNCUP and should be considered in future studies of treatment deintensification in this group. Treatment deintensification to radiotherapy alone in cN2/cN3 cases may result in poorer patient survival for HPV‐negative patients, whereas it may be a promising option for further investigation in HPV‐positive patients.Level of Evidence4 Laryngoscope, 129:684–691, 2019

Từ khóa


Tài liệu tham khảo

American Cancer Society, 2017, Cancer Facts & Figures 2017

10.1177/0194599814538605

10.1016/j.amjoto.2010.05.004

10.1007/s12094-009-0367-1

10.3109/02841869009090048

10.1093/annonc/mdg068

Mourad WF, 2014, Initial experience with oropharynx‐targeted radiation therapy for metastatic squamous cell carcinoma of unknown primary of the head and neck, Anticancer Res, 34, 243

10.1016/j.radonc.2009.08.027

10.1016/j.oraloncology.2016.12.033

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers (Version 2.2017). National Comprehensive Cancer Network;2017.

10.1002/hed.23479

10.1016/j.ijrobp.2009.09.006

10.1016/j.ijrobp.2009.11.020

10.1016/j.ijrobp.2011.01.014

10.1093/annonc/mdg330

10.1016/j.ijrobp.2010.04.029

10.1002/lary.22424

10.1158/1078-0432.CCR-13-2585

10.1158/1078-0432.CCR-05-2017

10.1002/ijc.27699

10.1002/cncr.30195

10.1002/cncr.31104

10.1200/JCO.2011.36.4596

10.1016/j.semradonc.2011.12.004

10.1002/ijc.30608

10.1200/JCO.2005.04.6136

10.1093/jnci/djn011

10.1002/lary.23493

10.1200/JCO.2010.29.2904

10.1056/NEJMoa0912217

10.1093/annonc/mdu167

10.1016/j.ejca.2016.09.006

10.1016/j.ejca.2016.12.020

10.1186/s40463-017-0223-1

10.1002/cam4.199

10.1002/hed.23514

10.1056/NEJMoa0912217

10.1002/cncr.30570

10.1245/s10434-007-9747-3

10.1002/lary.26809

10.1002/lary.26259

10.1200/JCO.2016.67.3863

10.1177/0194599817742596

10.1001/jamaoto.2018.0183

10.1002/hed.24984

10.1016/0895-4356(94)90129-5

10.1016/j.oraloncology.2015.03.015

10.1186/1471-2407-13-220

10.1016/j.critrevonc.2016.05.002

10.18632/oncotarget.4863

10.1016/j.radonc.2013.03.013

10.1007/s00066-014-0605-5

10.1016/j.soc.2015.03.007

10.1001/jamaoto.2013.5189

10.1016/j.oraloncology.2012.05.026

10.1371/journal.pone.0095364

10.1159/000363190

10.1245/s10434-015-4808-5

10.1200/JCO.2011.38.4099

10.1177/0194599818756830

Thông tin
Thông tin xuất bản

Laryngoscope

Tập 129 Số 3

684-691

Thông tin tác giả