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Does HPV type affect outcome in oropharyngeal cancer.doc

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Does HPV type affect outcome in oropharyngeal cancer

Nicholsetal.JournalofOtolaryngology-HeadandNeckSurgery2013,42:9 /content/42/1/9 ORIGINAL RESEARCH ARTICLE OpenAccess DoesHPVtypeaffectoutcomeinoropharyngeal cancer? AnthonyCNichols1,2,3,4,5*,SandeepSDhaliwal1,DavidAPalma2,3,4,JohnBasmaji1,CorinaChapeskie1, SamuelDowthwaite1,JasonHFranklin1,2,4,KevinFung1,2,4,KeithKwan5,BrettWehrli5,ChrisHowlett5, IramSiddiqui5,MarinaISalvadori6,EricWinquist2,4,ScottErnst2,4,SaraKuruvilla2,4,NancyRead2,4, VaragurVenkatesan2,4,BiljanaTodorovic2,7,JAlexHammond2,4,JamesKoropatnick2,3,4,7,JoeSMymryk2,3,4,7 JohnYoo1,2,4?andJohnWBarrett1,2,3,4? , Abstract Background:Anepidemicofhumanpapillomavirus(HPV)-relatedoropharyngealsquamouscellcancer(OPSCC) hasbeenreportedworldwidelargelyduetooralinfectionwithHPVtype-16,whichisresponsibleforapproximately 90%ofHPV-positivecases.ThepurposeofthisstudywastodeterminetherateofHPV-positiveoropharyngeal cancerinSouthwesternOntario,Canada. Methods:Aretrospectivesearchidentifiedninety-fivepatientsdiagnosedwithOPSCC.Pre-treatmentbiopsy specimensweretestedforp16expressionusingimmunohistochemistryandforHPV-16,HPV-18andotherhigh-risk subtypes,including31,33,35,39,45,51,52,56,58,59,67,68,byreal-timeqPCR. Results:Fifty-ninetumours(62%)werepositiveforp16expressionandfifty(53%)werepositiveforknownhigh-risk HPVtypes.Ofthelatter,45tumors(90%)wereidentifiedasHPV-16positive,andfivetumors(10%)werepositivefor otherhigh-riskHPVtypes(HPV-18(2),HPV-67(2),HPV-33(1)).HPVstatusbyqPCRandp16expressionwere extremelytightlycorrelated(p0.001,Fishersexacttest).PatientswithHPV-positivetumorshadimproved3-year overall(OS)anddisease-freesurvival(DFS)comparedtopatientswithHPV-negativetumors(90%vs65%,p=0.001; and85%vs49%,p=0.005;respectively).HPV-16relatedOPSCCpresentedwithcervicalmetastasesmorefrequently thanotherhigh-riskHPVtypes(p=0.005)andpoorerdisease-freesurvivalwasobserved,althoughthiswasnot statisticallysignificant. Conclusion:HPV-16infectionisresponsibleforasignificantproportionofOPSCCinSouthwesternOntario.Other high-risksubtyp