Human papillomavirus status and prognosis of oropharyngeal high-grade neuroendocrine carcinoma

Luana G de Sousa; Felippe Lazar Neto; Eduardo A Dal Lago; Andrew Sikora; Ehab Hanna; Amy Moreno; Jack Phan; Bonnie S Glisson; Diana Bell; Renata Ferrarotto

doi:10.1016/j.oraloncology.2023.106311

Human papillomavirus status and prognosis of oropharyngeal high-grade neuroendocrine carcinoma

Oral Oncol. 2023 Mar:138:106311. doi: 10.1016/j.oraloncology.2023.106311. Epub 2023 Jan 24.

Authors

Affiliations

¹ Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
² Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
³ Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁴ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁵ Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
⁶ Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: rferrarotto@mdanderson.org.

PMID: 36702015
DOI: 10.1016/j.oraloncology.2023.106311

Abstract

Background: The prognostic impact of human papillomavirus (HPV) infection or smoking on oropharyngeal high-grade neuroendocrine carcinoma (HG-NEC) is not established.

Methods: Retrospective study with patients with oropharyngeal HG-NEC seen at MD Anderson Cancer Center from 1997 to 2020, and previously reported patients with oropharyngeal HG-NEC and known p16 and HPV status from the literature review. Survival was estimated with the Kaplan-Meier method, and survival differences assessed with the log-rank test and Cox proportional hazards models.

Results: Thirty patients were included; most had a heavy (≥10 pack-years) smoking history (52%), locoregional disease (stage III-IVB; 77%), and p16-positive tumor (92%). HPV was positive in 65% of tested samples (15/23). Of 24 patients treated with curative intent, the objective response rates was 90% (9/10) and 81% (17/21), respectively, for induction chemotherapy and definitive radiotherapy. During follow-up, 54% (13/24) recurred, mostly (11/13) at distant sites. Median overall survival (OS) was 46 months (95% CI, 14.3 - NA). OS was not associated with HPV status (HR 0.73, P = 0.6) or smoking (HR 1.16, P = 0.8). Among 63 patients with known HPV status after the literature review (19 HPV- and 44 HPV + ), HPV status remained unassociated with OS (P = 0.92).

Conclusions: This is the largest retrospective cohort of oropharyngeal HG-NEC. Distant recurrence rate after curative treatment was high, suggesting that multimodality treatment including systemic therapy may benefit patients with locally advanced disease. HPV infection did not affect survival outcomes, therefore should not lead to therapy de-intensification for this histology.

Keywords: Head and neck neoplasms; Human papillomavirus; Neuroendocrine carcinoma; Oropharynx; Small cell carcinoma.

Publication types

Review

MeSH terms

Carcinoma, Neuroendocrine*
Carcinoma, Squamous Cell* / pathology
Human Papillomavirus Viruses
Humans
Oropharyngeal Neoplasms*
Papillomaviridae
Papillomavirus Infections*
Prognosis
Retrospective Studies