Human papillomavirus in head and neck squamous cell carcinoma of unknown primary is a common event and a strong predictor of survival

David Hebbelstrup Jensen; Nora Hedback; Lena Specht; Estrid Høgdall; Elo Andersen; Marianne Hamilton Therkildsen; Lennart Friis-Hansen; Bodil Norrild; Christian von Buchwald

doi:10.1371/journal.pone.0110456

Human papillomavirus in head and neck squamous cell carcinoma of unknown primary is a common event and a strong predictor of survival

David Hebbelstrup Jensen, Nora Hedback, Lena Specht, Estrid Høgdall, Elo Andersen, Marianne Hamilton Therkildsen, Lennart Friis-Hansen, Bodil Norrild, Christian von Buchwald

31 Citations (Scopus)

Abstract

BACKGROUND: The purpose of this study was to examine the prevalence of human papillomavirus (HPV) in patients with head and neck squamous cell carcinoma of unknown primary (CUP).

METHODS: All patients diagnosed with and treated for CUP between January 1, 2000, and June 1, 2011, at two Danish medical centers were included. All patients received a thorough diagnostic work-up, including FDG-PET, before being diagnosed as CUP. We determined the HPV status in all patients using a combination of HPV DNA PCR and p16 stain. In addition, clinical information on the study patients was retrieved from clinical records.

RESULTS: Of the identified 60 patients with CUP, 13 were shown to be positive for HPV DNA, amounting to 22% of the study population. In addition, we were able to show a clear disease-free and overall-survival benefit in the HPV-positive group, with a hazard ratio of 0.16 (95% CI: 0.038-0.67) for over-all survival. This survival benefit was also apparent when adjusted for advanced age in a multivariate Cox regression analysis.

CONCLUSION: A fairly large percentage of CUP cases are HPV-related, and because this is related to both the location and prognosis, we recommend HPV testing as part of the diagnostic work-up.

Original language	English
Article number	e110456
Journal	PLOS ONE
Volume	9
Issue number	11
Pages (from-to)	1-8
Number of pages	8
ISSN	1932-6203
DOIs	https://doi.org/10.1371/journal.pone.0110456
Publication status	Published - Nov 2014

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title = "Human papillomavirus in head and neck squamous cell carcinoma of unknown primary is a common event and a strong predictor of survival",

abstract = "BACKGROUND: The purpose of this study was to examine the prevalence of human papillomavirus (HPV) in patients with head and neck squamous cell carcinoma of unknown primary (CUP).METHODS: All patients diagnosed with and treated for CUP between January 1, 2000, and June 1, 2011, at two Danish medical centers were included. All patients received a thorough diagnostic work-up, including FDG-PET, before being diagnosed as CUP. We determined the HPV status in all patients using a combination of HPV DNA PCR and p16 stain. In addition, clinical information on the study patients was retrieved from clinical records.RESULTS: Of the identified 60 patients with CUP, 13 were shown to be positive for HPV DNA, amounting to 22% of the study population. In addition, we were able to show a clear disease-free and overall-survival benefit in the HPV-positive group, with a hazard ratio of 0.16 (95% CI: 0.038-0.67) for over-all survival. This survival benefit was also apparent when adjusted for advanced age in a multivariate Cox regression analysis.CONCLUSION: A fairly large percentage of CUP cases are HPV-related, and because this is related to both the location and prognosis, we recommend HPV testing as part of the diagnostic work-up.",

author = "Jensen, {David Hebbelstrup} and Nora Hedback and Lena Specht and Estrid H{\o}gdall and Elo Andersen and Therkildsen, {Marianne Hamilton} and Lennart Friis-Hansen and Bodil Norrild and {von Buchwald}, Christian",

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AU - Jensen, David Hebbelstrup

AU - Hedback, Nora

AU - Specht, Lena

AU - Høgdall, Estrid

AU - Andersen, Elo

AU - Therkildsen, Marianne Hamilton

AU - Friis-Hansen, Lennart

AU - Norrild, Bodil

AU - von Buchwald, Christian

PY - 2014/11

Y1 - 2014/11

N2 - BACKGROUND: The purpose of this study was to examine the prevalence of human papillomavirus (HPV) in patients with head and neck squamous cell carcinoma of unknown primary (CUP).METHODS: All patients diagnosed with and treated for CUP between January 1, 2000, and June 1, 2011, at two Danish medical centers were included. All patients received a thorough diagnostic work-up, including FDG-PET, before being diagnosed as CUP. We determined the HPV status in all patients using a combination of HPV DNA PCR and p16 stain. In addition, clinical information on the study patients was retrieved from clinical records.RESULTS: Of the identified 60 patients with CUP, 13 were shown to be positive for HPV DNA, amounting to 22% of the study population. In addition, we were able to show a clear disease-free and overall-survival benefit in the HPV-positive group, with a hazard ratio of 0.16 (95% CI: 0.038-0.67) for over-all survival. This survival benefit was also apparent when adjusted for advanced age in a multivariate Cox regression analysis.CONCLUSION: A fairly large percentage of CUP cases are HPV-related, and because this is related to both the location and prognosis, we recommend HPV testing as part of the diagnostic work-up.

AB - BACKGROUND: The purpose of this study was to examine the prevalence of human papillomavirus (HPV) in patients with head and neck squamous cell carcinoma of unknown primary (CUP).METHODS: All patients diagnosed with and treated for CUP between January 1, 2000, and June 1, 2011, at two Danish medical centers were included. All patients received a thorough diagnostic work-up, including FDG-PET, before being diagnosed as CUP. We determined the HPV status in all patients using a combination of HPV DNA PCR and p16 stain. In addition, clinical information on the study patients was retrieved from clinical records.RESULTS: Of the identified 60 patients with CUP, 13 were shown to be positive for HPV DNA, amounting to 22% of the study population. In addition, we were able to show a clear disease-free and overall-survival benefit in the HPV-positive group, with a hazard ratio of 0.16 (95% CI: 0.038-0.67) for over-all survival. This survival benefit was also apparent when adjusted for advanced age in a multivariate Cox regression analysis.CONCLUSION: A fairly large percentage of CUP cases are HPV-related, and because this is related to both the location and prognosis, we recommend HPV testing as part of the diagnostic work-up.

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Human papillomavirus in head and neck squamous cell carcinoma of unknown primary is a common event and a strong predictor of survival

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