Human Papillomavirus and Prognosis of Oropharyngeal Squamous Cell Carcinoma: Implications for Clinical Research in Head and Neck Cancers
1/9/2007 Baltimore, MD Maura L. Gillison Journal of Clinical Oncology, Vol 24, No 36 (December 20), 2006: pp. 5623-5625 Oropharyngeal squamous cell carcinomas are etiologically heterogeneous, with one subset attributable primarily to human papillomavirus (HPV) infection and another to alcohol and tobacco use. These subsets are clinically and molecularly distinct, and these distinctions extend to patient prognosis.1 In this issue of the Journal of Clinical Oncology, Licitra et al2 report that patients with HPV DNA–positive oropharyngeal cancers have an approximately 60% reduction in 5-year mortality when compared with patients with HPV-negative tumors, who have a considerably worse prognosis. These data corroborate several previous single-institutional, retrospective analyses that reported similarly improved disease-specific and overall survival in HPV-positive patients.3-8 Retrospective analyses, such as those performed in this study, must be interpreted with caution because of limited quality of retrospectively collected data, sample size constraints, and the potential for residual confounding. However, in a prospective, population-based, observational study, the association between HPV status and prognosis strengthened after adjustment for potential confounders.9 Indeed, tumor HPV status was as important to patient prognosis as tumor stage. Therefore, the association between tumor HPV status and prognosis is now sufficiently strong and consistent such that its impact on clinical research involving head and neck cancer patients must be considered. As for any cancer prognostic biomarker with potential clinical utility, research involving HPV tumor status is strongly dependent on the performance of the assay used for HPV detection as well as the definition of a positive test.10 Classification [...]