comparison of clinicopathological and prognostic features of HPV positive and HPV negative head and neck squamous cell carcinoma (HNSCC)

Squamous cell carcinoma accounts for 95% of head and neck cancers (HNSCC). Recently, Human papilloma virus associated HNSCC have shown rising incidence rates specifically caused by HPV-16 subtype. There have been limited data to differentiate the pathological and prognostic behaviors of HPV+ versus HPV- HNSCC. So, that is the aim of our study.

Data of 8802 HNSCC patients were extracted from the Surveillance, Epidemiological, and End Results (SEER) database diagnosed from 2000-2020. The histopathological classification of HPV+ and HPV- HNSCC were according to WHO ICD-0-3 classification. Cox regression hazard model was performed using SPSS 25 to assess age, race, sex, radiotherapy, chemotherapy and surgery as predictors for outcome.

HPV+ and HPV- HNSCC were found to be more common in males and white race. Increasing age was associated with poorer prognosis in HPV+ with a hazard ratio (HR) of 1.05; P<0.05, however it was insignificant predictor for HPV-; P>0.05. Surgery, radiotherapy and chemotherapy were all associated with better outcomes for HPV+; HR: 0.21, 0.23, 0.83; respectively; P<0.05. For HPV-, having surgery and radiotherapy were significant good prognostic factors; HR: 0.35 and 0.28 respectively; P<0.05. while chemotherapy wasn’t significant; P>0.05. Race and Sex weren’t statistically significant for HPV+ and HPV- HNSCC.

HPV+ HNSCC Showed an overall better prognosis than HPV- HNSCC. In terms of demographic characteristics. Increasing age had a poor prognostic outcome for HPV+ but no impact on prognosis for HPV-. Age and Sex were insignificant predictors for both groups. Surgery and Radiotherapy showed better prognostic value for both groups. Our results showed better outcomes of surgery and radiotherapy in HPV+ HNSCC compared to HPV- HNSCC. Chemotherapy showed slightly good prognostic outcomes for HPV+ but had no impact on outcomes for HPV-. We recommend radiotherapy and surgery to be the first line of treatment for both HPV+ and HPV- HNSCC. Chemotherapy can be preserved for selective HPV+ patients while for HPV- it had no value so, we don't recommend and we can avoid unnecessary side effects unless there are other indications.