2016_Head & Neck COURSE BOOK

ORIGINAL ARTICLE HPV AND NECK METASTASIS FROM UNKNOWN PRIMARY

Impact of p16 expression, nodal status, and smoking on oncologic outcomes of patients with head and neck unknown primary squamous cell carcinoma

Dixon et al, Head Neck (2016)

Peter R. Dixon, MD, 1 Michael Au, MD, 1 Ali Hosni, MD, Bayardo Perez–Ordonez, MD, FRCPC, 2 Ilan Weinreb, MD, FRCPC, 2 Wei Xu, PhD, 4 Yuyao Song, MMath, 4 Shao Hui Huang, MRT(T), MSc, 3 Brian O’Sullivan, MD, FRCPC, 3 David P. Goldstein, MD, MSc, FRCSC, 1 John R. de Almeida, MD, MSc, FRCSC 1 * 1 Department of Otolaryngology – Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada, 2 Department of Pathology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada, 3 Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada, 4 Department of Biostatistics, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada. n=73

Accepted 2 February 2016 Published online 00 Month 2016 in Wiley Online Library (wileyonlinelibrary.com). DOI 10.1002/hed.24441

ABSTRACT: Background. The prognostic significance of human papillo- mavirus (HPV) in the context of head and neck squamous cell carcinoma (HNSCC) of cancer of unknown primary (CUP) origin is unclear. Methods. Patients treated for CUP at the Princess Margaret Cancer Centre between 2001 and 2013 were stratified by p16 status and retro- spectively reviewed. Results. Of the 73 patients included, those with p16-positive tumors (63%) had less advanced nodal status (N1–N2b; 52% vs 89%; p 5 .035) and less aggressive treatment. Patients with p16-positive tumors

had improved 3-year disease-free survival (DFS; 79% vs 56%; p 5 .012) independent of nodal status and treatment in multivariable analysis (hazard ratio [HR] 5 0.27; 95% confidence interval [CI] 5 0.08–0.95). Conclusion. Among patients with CUP, p16-positive status is an inde- pendent predictor of DFS but not overall survival (OS). V C 2016 Wiley Periodicals, Inc. Head Neck 00 : 000–000, 2016 KEY WORDS: unknown primary neoplasms, head and neck neo- plasms, squamous cell carcinoma, human papilloma virus, p16

ated with unnecessary toxicity. 7–9 More tailored regimens now exist based on risk factors for nasopharyngeal, oro- pharyngeal, or a hypopharyngeal primary site. 10,11 It has recently been suggested that the majority of

INTRODUCTION Head and neck squamous cell carcinomas (HNSCCs) often present with metastatic cervical lymphadenopathy.

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