A prospective cohort study of HPV-driven oropharyngeal cancers; implications for prognosis and immunisation

Wakeham, Katie and Pan, Jiafeng and Pollock, Kevin G and Millan, David and Bell, Sarah and McLellen, Douglas and McPhaden, Allan and Conway, David I and Graham, Sheila V and Kavanagh, Kimberley and Cuschieri, Kate (2019) A prospective cohort study of HPV-driven oropharyngeal cancers; implications for prognosis and immunisation. Clinical Oncology, 31 (9). pp. 132-142. ISSN 0936-6555 (https://doi.org/10.1016/j.clon.2019.05.010)

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Oropharyngeal cancer (OPC) is increasing on a global scale, including the component driven by high-risk human papillomavirus (HR-HPV); contemporary data that provide insight into the prognosis of this disease in addition to the fraction attributable to HR-HPV are essential to inform primary and secondary disease management strategies. A population-based cohort of 235 patients diagnosed with OPC between 2013-15 in Scotland was assessed for HPV status using molecular genotyping. Associations between HR-HPV status and key clinical and demographic variables were estimated using the Pearson chi-squared test. Rates of overall survival (OS) and progression-free survival (PFS) were estimated and visualized using Kaplan–Meier curves. HPV DNA (largely HPV 16) was identified in 60% of cases. After adjustment for age, gender, deprivation, smoking, alcohol consumption and tumour stage, patients with HR-HPV positive OPC had 89% reduction in risk of death (HR = 0.11, 95% CI 0.05-0.25), and an 85% reduction in risk of disease progression (HR = 0.15 95% CI 0.07-0.30). HPV positivity was not associated with age, deprivation or smoking status, whereas those who reported excess alcohol consumption were less likely to be HPV positive. The prevalence of HPV-associated OPC is high in Scotland and strongly associated with dramatically improved clinical outcomes including survival. Demographic/behavioural variables did not reliably predict HPV positivity in this cohort which underlines the importance of laboratory confirmation. Finally, the dominance of HPV 16 in OPC indicates the significant impact of prophylactic immunisation on this disease.