AUTHOR=Wu Qiuji , Wang Miao , Liu Yixin , Wang Xulong , Li Yi , Hu Xiaoyan , Qiu Ye , Liang Wenjing , Wei Yongchang , Zhong Yahua 

TITLE=HPV Positive Status Is a Favorable Prognostic Factor in Non-Nasopharyngeal Head and Neck Squamous Cell Carcinoma Patients: A Retrospective Study From the Surveillance, Epidemiology, and End Results Database

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.688615

DOI=10.3389/fonc.2021.688615

ISSN=2234-943X

ABSTRACT=Objective: To investigate the impact of human papillomavirus (HPV) status on head and neck squamous cell carcinoma (HNSCC) arising from different anatomic subsites.
Methods: HNSCC patients with known HPV status from the Surveillance, Epidemiology, and End Results (SEER) database between 2010-2015 were included in our analysis. Patients were classified into three categories of HNSCC according to Site recode ICD-O-3/WHO 2008 and Primary Site -labeled, namely oropharynx, hypopharynx and nasopharynx. Logistic regression model was conducted to evaluate the relationship between patient characteristics and HPV status. Kaplan-Meier methods and COX regression analysis were used to analyze survival data. 
Results: 9943 HNSCC patients with known HPV status from SEER database were enrolled, with 6829 (68.7%) HPV-positive patients. HPV-positive and HPV-negative HNSCC were distinct and had different clinical and socioeconomic feature (all P<0.001). Primary sites, socioeconomical factors (age, sex, marital status and race) and pathological features (TNM stage and grade) were closely related with HPV status (all P<0.001). HPV-positive status was a favorable prognostic marker in HNSCC patients with cancers of the oropharynx, hypopharynx (all P<0.001), but was not in nasopharyngeal carcinoma patients (P=0.843). A total of 8933 oropharyngeal carcinoma (OPC) and 558 hypopharyngeal carcinoma (HPC) patients were divided into the training and validation cohorts with a ratio of 1:1. Significant prognostic factors of OS yielded by multivariate COX analysis in training cohort were integrated to construct nomograms for OPC and HPC patients. The prognostic models showed good discrimination with a C-index of 0.79 ± 0.007 and 0.73 ± 0.023 in OPC and HPC, respectively. Favorable calibration was reflected by the calibration curves. Additionally, corresponding risk classification systems for OPC and HPC patients based on the nomograms were built and could perfectly classify patients into low-risk, intermediated-risk, high-risk groups. OS in three risk groups was accurately differentiated and showed good discrimination.
Conclusion: HPV positivity was associated with improved survival in HNSCC patients with cancers of the oropharynx, hypopharynx. Nomograms and corresponding risk classification systems were constructed to assist clinicians in evaluating survival of OPC and HPC patients.