Human papillomavirus reduces the prognostic value of nodal involvement in tonsillar squamous cell carcinomas

Laryngoscope. 2009 Oct;119(10):1951-7. doi: 10.1002/lary.20593.


Objectives/hypothesis: Assessment of the prognostic value of nodal status in relation to human papillomavirus (HPV) status and the various treatment modalities in tonsillar squamous cell carcinomas (TSCC).

Study design: Retrospective 5-year survival analysis.

Methods: A 5-year follow-up of disease-free, disease-specific, and overall survival in a group of 81 patients with TSCC was conducted. The nodal status and integration of HPV-DNA in the genome (detected with fluorescence in situ hybridization) as prognostic indicators were examined while correcting for other clinical parameters (smoking habits, alcohol consumption, treatment modality, differentiation, TNM classification).

Results: Of TSCCs, 41% were positive for HPV type 16. In these TSCCs, the primary tumor was significantly smaller when compared to HVP-negative TSCCs (P = .04), whereas the percentage of cases with cervical metastases was identical. In the total population, it was not nodal involvement, but rather HPV manifestation, which was related to patient prognosis. Within the treatment modalities (surgery combined with radiotherapy and radiotherapy alone), neither nodal status nor HPV were prognostic indicators.

Conclusions: Since a substantial percentage of TSCCs are HPV-positive and metastasizes to cervical lymph nodes in less advanced primary tumors, the N status is an unreliable prognostic indicator in TSCCs. HPV is only prognostically relevant in the total tumor population, but loses its value within patient groups receiving a single treatment modality. The value of HPV for prognosis of patients with TSCC requires further study.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Alcohol Drinking / epidemiology
  • Alphapapillomavirus / isolation & purification*
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / mortality*
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / virology*
  • DNA, Viral / analysis
  • Disease-Free Survival
  • Female
  • Humans
  • In Situ Hybridization, Fluorescence
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Smoking / epidemiology
  • Tonsillar Neoplasms / epidemiology
  • Tonsillar Neoplasms / mortality*
  • Tonsillar Neoplasms / pathology
  • Tonsillar Neoplasms / virology*


  • DNA, Viral