Observational studyHead and neck cancers

Human Papillomavirus and Rising Oropharyngeal Cancer Incidence in the United States

JCO · 2011271 oropharyngeal cancer cases (1984 to 2004)

Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, et al. JCO. 2011. 29:4294-4301

Study type: Observational study
Design: Population-based cohort study using tissue samples from cancer registries (SEER Residual Tissue Repositories Program)
Sample size: 271 oropharyngeal cancer cases (1984 to 2004)
Source: JCO · 2011

In plain words

This research showed that in the United States, the share of throat (oropharyngeal) cancers linked to the human papillomavirus (HPV) rose sharply from the 1980s to 2004. Patients whose tumour was HPV-positive lived, on average, much longer than patients whose tumour was HPV-negative. The authors predicted that if this trend continued, the yearly number of these cancers would exceed the number of cervical cancers by 2020.

Key results

From 16.3% in 1984 to 1989 to 71.7% in 2000 to 2004

HPV prevalence by Inno-LiPA

Significant increasing trend with all detection methods (P trend < 0.05)

131 vs 20 months

Median survival (HPV-positive vs HPV-negative)

Log-rank P < 0.001

0.31

Adjusted hazard ratio for death (HPV-positive vs negative)

95% CI 0.21–0.46

Significant increase in HPV-positive (P = 0.003); no significant increase in HPV-negative (P = 0.18)

Survival trend over time

225% increase (from 0.8 to 2.6 per 100,000)

Incidence of HPV-positive oropharyngeal cancer (1988 to 2004)

95% CI 208%–242%

50% decrease (from 2.0 to 1.0 per 100,000)

Incidence of HPV-negative oropharyngeal cancer (1988 to 2004)

95% CI 47%–53%

Treatment arms and regimens

1HPV-positive oropharyngeal cancers

This was not an interventional study; HPV status was determined by PCR and genotyping (Inno-LiPA), HPV16 viral load and HPV16 mRNA expression.

2HPV-negative oropharyngeal cancers

This was not an interventional study; HPV-negative patients were compared with the HPV-positive group for survival and incidence.

Source of the regimen details: Abstract of the paper

Doses are given for the information of specialists, as in this study’s protocol, and are not a prescription. Every drug must be prescribed by the treating physician for the individual patient.

Study population

All 271 oropharyngeal cancer cases (1984 to 2004) collected by three population-based cancer registries in the SEER Residual Tissue Repositories Program.

Endpoints

Trends in HPV prevalence over four calendar periods, comparison of survival between HPV-positive and HPV-negative patients, and population-level incidence trends (after reweighting the observed prevalence to all oropharyngeal cancers in the cancer registries).

Safety and side effects

This was not an interventional study, and treatment-related adverse events are not reported.

Clinical significance and place in guidelines

This study provided empirical evidence for the role of HPV in the rising incidence and improved survival of oropharyngeal cancer and highlights the importance of determining HPV status in these tumours. According to the abstract, its impact on treatment or vaccination guidelines is not specified, and the status of current recommendations should be checked in authoritative guidelines.

Limitations

According to the abstract: the number of samples was limited (271 cases) and came from three cancer registries, and HPV prevalence was reweighted to compensate for non-random sample selection. The data extend only to 2004, and the 2020 projection assumes that recent trends continue. Other limitations should be checked in the full paper.

Original article (DOI)PubMed

This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.