n e w e ng l a n d j o u r na l
m e dic i n e
Human Papillomavirus and Survival of Patients with Oropharyngeal Cancer
K. Kian Ang, M.D., Ph.D., JonathanHarris, M.S., Richard Wheeler, M.D., Randal Weber, M.D., David I. Rosenthal, M.D., Phuc Felix Nguyen-Tân, M.D., William H. Westra, M.D., Christine H. Chung, M.D., Richard C. Jordan, D.D.S., Ph.D., CharlesLu, M.D., Harold Kim, M.D., Rita Axelrod, M.D., C. Craig Silverman, M.D., Kevin P. Redmond, M.D., and Maura L. Gillison, M.D., Ph.D.
A BS T R AC T
Oropharyngeal squamous-cellcarcinomas caused by human papillomavirus (HPV) are associated with favorable survival, but the independent prognostic significance of tumor HPV status remains unknown.
We performed aretrospective analysis of the association between tumor HPV status and survival among patients with stage III or IV oropharyngeal squamous-cell carcinoma who were enrolled in a randomized trial comparingaccelerated-fractionation radiotherapy (with acceleration by means of concomitant boost radiotherapy) with standard-fractionation radiotherapy, each combined with cisplatin therapy, in patients withsquamous-cell carcinoma of the head and neck. Proportional-hazards models were used to compare the risk of death among patients with HPV-positive cancer and those with HPV-negative cancer.
Themedian follow-up period was 4.8 years. The 3-year rate of overall survival was similar in the group receiving accelerated-fractionation radiotherapy and the group receiving standard-fractionationradiotherapy (70.3% vs. 64.3%; P = 0.18; hazard ratio for death with accelerated-fractionation radiotherapy, 0.90; 95% confidence interval [CI], 0.72 to 1.13), as were the rates of high-grade acute and latetoxic events. A total of 63.8% of patients with oropharyngeal cancer (206 of 323) had HPV-positive tumors; these patients had better 3-year rates of overall survival (82.4%, vs. 57.1% among patients...