A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation

K. Wakeham, J. Pan, K.G. Pollock, D. Millan, S. Bell, D. McLellan, A. McPhaden, D.I. Conway, S.V. Graham, K. Kavanagh, K. Cuschieri

Research output: Contribution to journalArticle

Abstract

AIMS:

Oropharyngeal cancer (OPC) is increasing on a global scale, including the component driven by high-risk human papillomavirus (HR-HPV); contemporary data that provides insight into the prognosis of this disease in addition to the fraction attributable to HR-HPV are essential to inform primary and secondary disease management strategies.

MATERIALS AND METHODS:

A population-based cohort of 235 patients diagnosed with OPC between 2013 and 2015 in Scotland was assessed for HPV status using molecular genotyping. Associations between HR-HPV status and key clinical and demographic variables were estimated using the Pearson chi-squared test. Rates of overall survival and progression-free survival were estimated and visualised using Kaplan-Meier curves.

RESULTS:

HPV DNA (largely HPV 16) was identified in 60% of cases. After adjustment for age, gender, deprivation, smoking, alcohol consumption and tumour stage, patients with HR-HPV-positive OPC had an 89% reduction in the risk of death (hazard ratio = 0.11, 95% confidence interval 0.05-0.25) and an 85% reduction in the risk of disease progression (hazard ratio = 0.15, 95% confidence interval 0.07-0.30). HPV positivity was not associated with age, deprivation or smoking status, whereas those who reported excess alcohol consumption were less likely to be positive for HR-HPV.

CONCLUSIONS:

The prevalence of HR-HPV-associated OPC is high in Scotland and strongly associated with dramatically improved clinical outcomes, including survival. Demographic/behavioural variables did not reliably predict HPV positivity in this cohort, which underlines the importance of laboratory confirmation. Finally, the dominance of HPV 16 in OPC indicates the significant impact of prophylactic immunisation on this disease.
Original languageEnglish
Pages (from-to)e132-e142
Number of pages11
JournalClinical Oncology
Volume31
Issue number9
Early online date25 Jun 2019
DOIs
Publication statusPublished - Sep 2019

Fingerprint

Oropharyngeal Neoplasms
Immunization
Cohort Studies
Prospective Studies
Human papillomavirus 16
Scotland
Risk Reduction Behavior
Alcohol Drinking
Smoking
Demography
Confidence Intervals
Disease Management
Disease-Free Survival
Disease Progression
Survival Rate
Survival
DNA
Population
Neoplasms

Keywords

  • HPV vaccine
  • cancer
  • oropharyngeal

Cite this

Wakeham, K. ; Pan, J. ; Pollock, K.G. ; Millan, D. ; Bell, S. ; McLellan, D. ; McPhaden, A. ; Conway, D.I. ; Graham, S.V. ; Kavanagh, K. ; Cuschieri, K. / A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation. In: Clinical Oncology . 2019 ; Vol. 31, No. 9. pp. e132-e142.
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title = "A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation",
abstract = "AIMS: Oropharyngeal cancer (OPC) is increasing on a global scale, including the component driven by high-risk human papillomavirus (HR-HPV); contemporary data that provides insight into the prognosis of this disease in addition to the fraction attributable to HR-HPV are essential to inform primary and secondary disease management strategies.MATERIALS AND METHODS: A population-based cohort of 235 patients diagnosed with OPC between 2013 and 2015 in Scotland was assessed for HPV status using molecular genotyping. Associations between HR-HPV status and key clinical and demographic variables were estimated using the Pearson chi-squared test. Rates of overall survival and progression-free survival were estimated and visualised using Kaplan-Meier curves.RESULTS: HPV DNA (largely HPV 16) was identified in 60{\%} of cases. After adjustment for age, gender, deprivation, smoking, alcohol consumption and tumour stage, patients with HR-HPV-positive OPC had an 89{\%} reduction in the risk of death (hazard ratio = 0.11, 95{\%} confidence interval 0.05-0.25) and an 85{\%} reduction in the risk of disease progression (hazard ratio = 0.15, 95{\%} confidence interval 0.07-0.30). HPV positivity was not associated with age, deprivation or smoking status, whereas those who reported excess alcohol consumption were less likely to be positive for HR-HPV.CONCLUSIONS: The prevalence of HR-HPV-associated OPC is high in Scotland and strongly associated with dramatically improved clinical outcomes, including survival. Demographic/behavioural variables did not reliably predict HPV positivity in this cohort, which underlines the importance of laboratory confirmation. Finally, the dominance of HPV 16 in OPC indicates the significant impact of prophylactic immunisation on this disease.",
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Wakeham, K, Pan, J, Pollock, KG, Millan, D, Bell, S, McLellan, D, McPhaden, A, Conway, DI, Graham, SV, Kavanagh, K & Cuschieri, K 2019, 'A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation', Clinical Oncology , vol. 31, no. 9, pp. e132-e142. https://doi.org/10.1016/j.clon.2019.05.010

A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation. / Wakeham, K.; Pan, J.; Pollock, K.G.; Millan, D.; Bell, S.; McLellan, D.; McPhaden, A.; Conway, D.I.; Graham, S.V.; Kavanagh, K.; Cuschieri, K.

In: Clinical Oncology , Vol. 31, No. 9, 09.2019, p. e132-e142.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A prospective cohort study of human papillomavirus-driven oropharyngeal cancers: implications for prognosis and immunisation

AU - Wakeham, K.

AU - Pan, J.

AU - Pollock, K.G.

AU - Millan, D.

AU - Bell, S.

AU - McLellan, D.

AU - McPhaden, A.

AU - Conway, D.I.

AU - Graham, S.V.

AU - Kavanagh, K.

AU - Cuschieri, K.

N1 - Acceptance from webpage AAM: 12m embargo

PY - 2019/9

Y1 - 2019/9

N2 - AIMS: Oropharyngeal cancer (OPC) is increasing on a global scale, including the component driven by high-risk human papillomavirus (HR-HPV); contemporary data that provides insight into the prognosis of this disease in addition to the fraction attributable to HR-HPV are essential to inform primary and secondary disease management strategies.MATERIALS AND METHODS: A population-based cohort of 235 patients diagnosed with OPC between 2013 and 2015 in Scotland was assessed for HPV status using molecular genotyping. Associations between HR-HPV status and key clinical and demographic variables were estimated using the Pearson chi-squared test. Rates of overall survival and progression-free survival were estimated and visualised using Kaplan-Meier curves.RESULTS: HPV DNA (largely HPV 16) was identified in 60% of cases. After adjustment for age, gender, deprivation, smoking, alcohol consumption and tumour stage, patients with HR-HPV-positive OPC had an 89% reduction in the risk of death (hazard ratio = 0.11, 95% confidence interval 0.05-0.25) and an 85% reduction in the risk of disease progression (hazard ratio = 0.15, 95% confidence interval 0.07-0.30). HPV positivity was not associated with age, deprivation or smoking status, whereas those who reported excess alcohol consumption were less likely to be positive for HR-HPV.CONCLUSIONS: The prevalence of HR-HPV-associated OPC is high in Scotland and strongly associated with dramatically improved clinical outcomes, including survival. Demographic/behavioural variables did not reliably predict HPV positivity in this cohort, which underlines the importance of laboratory confirmation. Finally, the dominance of HPV 16 in OPC indicates the significant impact of prophylactic immunisation on this disease.

AB - AIMS: Oropharyngeal cancer (OPC) is increasing on a global scale, including the component driven by high-risk human papillomavirus (HR-HPV); contemporary data that provides insight into the prognosis of this disease in addition to the fraction attributable to HR-HPV are essential to inform primary and secondary disease management strategies.MATERIALS AND METHODS: A population-based cohort of 235 patients diagnosed with OPC between 2013 and 2015 in Scotland was assessed for HPV status using molecular genotyping. Associations between HR-HPV status and key clinical and demographic variables were estimated using the Pearson chi-squared test. Rates of overall survival and progression-free survival were estimated and visualised using Kaplan-Meier curves.RESULTS: HPV DNA (largely HPV 16) was identified in 60% of cases. After adjustment for age, gender, deprivation, smoking, alcohol consumption and tumour stage, patients with HR-HPV-positive OPC had an 89% reduction in the risk of death (hazard ratio = 0.11, 95% confidence interval 0.05-0.25) and an 85% reduction in the risk of disease progression (hazard ratio = 0.15, 95% confidence interval 0.07-0.30). HPV positivity was not associated with age, deprivation or smoking status, whereas those who reported excess alcohol consumption were less likely to be positive for HR-HPV.CONCLUSIONS: The prevalence of HR-HPV-associated OPC is high in Scotland and strongly associated with dramatically improved clinical outcomes, including survival. Demographic/behavioural variables did not reliably predict HPV positivity in this cohort, which underlines the importance of laboratory confirmation. Finally, the dominance of HPV 16 in OPC indicates the significant impact of prophylactic immunisation on this disease.

KW - HPV vaccine

KW - cancer

KW - oropharyngeal

U2 - 10.1016/j.clon.2019.05.010

DO - 10.1016/j.clon.2019.05.010

M3 - Article

VL - 31

SP - e132-e142

JO - Clinical Oncology

JF - Clinical Oncology

SN - 0936-6555

IS - 9

ER -