PLoS ONE (Jan 2014)

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
https://doi.org/10.1371/journal.pone.0110456
Journal volume & issue
Vol. 9, no. 11
p. e110456

Abstract

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BackgroundThe 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).MethodsAll 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.ResultsOf 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.ConclusionA 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.