engleski

Relation of viral etiology of oropharyngeal tumors to the response rate of individual treatment modal

Introduction: HPV status itself is probably the strongest prognostic factor in head and neck cancer (HNC) and in the near future it will probably determine the treatment intensity but it may also affect the choice of treatment modality. Is seems probable, that the prognostic advantage of HPV positive cancers is not treatment dependent, but data evaluating the impact of HPV positivity on prognosis in patients treated by different modalities are sparse. Aim: The aim of the study is to compare the outcome in groups of patients treated by surgery in combination with postoperative radiation therapy (RT) with patients treated by different non-surgical approaches with regard to the HPV status. Methods: The study group consists of patients with oropharyngeal tumors stage III and IV. Out of 175 patients, 103 were treated by surgery and postoperative RT and 72 by chemotherapy and radiation therapy (CRT), concurrent RT and biological therapy, and RT only. HPV positive samples were those positive for both HPV DNA and expression of p16 protein. HPV DNA detection was done by means of PCR and the detection of p16 by immunohistochemistry. Survival analysis was done according to HPV status in both groups and also in the subgroups of different non-surgical therapies. Results: In the surgical group 64% of tumors were HPV positive, while it was only 36% in the group of patients treated non-surgically. The disease-specific survival rate of patients with HPV DNA positive tumors was significantly higher than that of HPV DNA-negative patients in both groups. However, the difference between survival of patients with HPV-positive and -negative tumors was more prominent in the surgical group. When stratified according to the treatment the survival was better in the surgical group. This difference is mainly due to the higher proportion of HPV-positive patients in the surgical group, but non significant survival advantage of the surgical group is present also in a matched analysis of the subgroups according to HPV status. Conclusions: Patients with HPV positive tumors have better prognosis regardless of the treatment modality.

HPV; HNSCC; survival

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