Eleni M Rettig1, Munfarid Zaidi1, Farhoud Faraji2, David W Eisele1, Margueritta El Asmar3, Nicholas Fung1, Gypsyamber D'Souza4, Carole Fakhry5. 1. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N Caroline St. 6(th) Floor, Baltimore, MD 21287, United States. 2. St. Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, United States. 3. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N Caroline St. 6(th) Floor, Baltimore, MD 21287, United States; Department of Oncology, Johns Hopkins University School of Medicine, 401 N Broadway, Baltimore, MD 21287, United States. 4. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N Caroline St. 6(th) Floor, Baltimore, MD 21287, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States. 5. Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N Caroline St. 6(th) Floor, Baltimore, MD 21287, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, United States. Electronic address: cfakhry@jhmi.edu.
Abstract
OBJECTIVES: HPV-positive oropharyngeal cancer (OPC) patients have been observed to be younger than patients with HPV-negative OPC at diagnosis. We evaluated recent trends in age at OPC diagnosis, and whether older age attenuates the survival benefit of HPV-positive tumor status. MATERIALS AND METHODS: Patients diagnosed with OPC from 2004 to 2014 represented in the National Cancer Database were included. HPV tumor status was available after 2010. Trends in age by calendar year were compared using linear regression. Overall survival was compared using Cox Proportional Hazards models. RESULTS: The mean age of OPC patients (N = 119,611) increased significantly from 2004 to 2014 (ß = 0.21 years of age per calendar year, 95% confidence interval [CI] = 0.19-0.23). The increase in age from 2010 to 2014 was similar for HPV-positive (N = 21,880; ß = 0.63, 95%CI = 0.53-0.72) and HPV-negative (N = 11,504; ß = 0.59, 95%CI = 0.45-0.74) patients. Between 2010 and 2014, the proportion of OPCs that were HPV-positive increased significantly for all age groups, including for patients ≥70 years old (from 45% to 60%, ptrend < 0.001). Although patients ≥70 years with HPV-OPC had improved survival compared to those with HPV-negative OPC (adjusted hazard ratio [aHR] = 0.65, 95%CI = 0.55-0.76), the survival benefit of HPV-positive tumor status was significantly attenuated compared to younger HPV-OPC patients (50-59 years: aHR = 0.45, 95%CI = 0.39-0.51; pinteraction < 0.001). CONCLUSION: The age at OPC diagnosis is increasing for both HPV-positive and HPV-negative patients, and a rising proportion of older patients have HPV-positive tumors. These findings dispel the notion that HPV-positive OPC is a disease of younger patients, identify a growing elderly population of HPV-positive OPC patients with reduced survival, and have implications for evolving treatment paradigms.
OBJECTIVES:HPV-positive oropharyngeal cancer (OPC) patients have been observed to be younger than patients with HPV-negative OPC at diagnosis. We evaluated recent trends in age at OPC diagnosis, and whether older age attenuates the survival benefit of HPV-positive tumor status. MATERIALS AND METHODS:Patients diagnosed with OPC from 2004 to 2014 represented in the National Cancer Database were included. HPV tumor status was available after 2010. Trends in age by calendar year were compared using linear regression. Overall survival was compared using Cox Proportional Hazards models. RESULTS: The mean age of OPC patients (N = 119,611) increased significantly from 2004 to 2014 (ß = 0.21 years of age per calendar year, 95% confidence interval [CI] = 0.19-0.23). The increase in age from 2010 to 2014 was similar for HPV-positive (N = 21,880; ß = 0.63, 95%CI = 0.53-0.72) and HPV-negative (N = 11,504; ß = 0.59, 95%CI = 0.45-0.74) patients. Between 2010 and 2014, the proportion of OPCs that were HPV-positive increased significantly for all age groups, including for patients ≥70 years old (from 45% to 60%, ptrend < 0.001). Although patients ≥70 years with HPV-OPC had improved survival compared to those with HPV-negative OPC (adjusted hazard ratio [aHR] = 0.65, 95%CI = 0.55-0.76), the survival benefit of HPV-positive tumor status was significantly attenuated compared to younger HPV-OPCpatients (50-59 years: aHR = 0.45, 95%CI = 0.39-0.51; pinteraction < 0.001). CONCLUSION: The age at OPC diagnosis is increasing for both HPV-positive and HPV-negative patients, and a rising proportion of older patients have HPV-positive tumors. These findings dispel the notion that HPV-positive OPC is a disease of younger patients, identify a growing elderly population of HPV-positive OPC patients with reduced survival, and have implications for evolving treatment paradigms.
Authors: K Kian Ang; Jonathan Harris; Richard Wheeler; Randal Weber; David I Rosenthal; Phuc Felix Nguyen-Tân; William H Westra; Christine H Chung; Richard C Jordan; Charles Lu; Harold Kim; Rita Axelrod; C Craig Silverman; Kevin P Redmond; Maura L Gillison Journal: N Engl J Med Date: 2010-06-07 Impact factor: 91.245
Authors: Stephanie A Michal; David J Adelstein; Lisa A Rybicki; Cristina P Rodriguez; Jerrold P Saxton; Benjamin G Wood; Joseph Scharpf; Denise I Ives Journal: Head Neck Date: 2011-10-22 Impact factor: 3.147
Authors: Caitriona B O'Neill; Shrujal S Baxi; Coral L Atoria; James P O'Neill; Martin C Henman; Eric J Sherman; Nancy Y Lee; David G Pfister; Elena B Elkin Journal: Cancer Date: 2015-02-27 Impact factor: 6.860
Authors: William M Lydiatt; Snehal G Patel; Brian O'Sullivan; Margaret S Brandwein; John A Ridge; Jocelyn C Migliacci; Ashley M Loomis; Jatin P Shah Journal: CA Cancer J Clin Date: 2017-01-27 Impact factor: 508.702
Authors: Zachary D Horne; Scott M Glaser; John A Vargo; Robert L Ferris; Goundappa K Balasubramani; David A Clump; Dwight E Heron; Sushil Beriwal Journal: Cancer Date: 2016-04-25 Impact factor: 6.860
Authors: Mitchell Machtay; Jennifer Moughan; Andrew Trotti; Adam S Garden; Randal S Weber; Jay S Cooper; Arlene Forastiere; K Kian Ang Journal: J Clin Oncol Date: 2008-06-16 Impact factor: 44.544
Authors: Joseph E Tota; Ana F Best; Zachary S Zumsteg; Maura L Gillison; Philip S Rosenberg; Anil K Chaturvedi Journal: J Clin Oncol Date: 2019-04-26 Impact factor: 44.544
Authors: Martine Froukje van der Kamp; Gyorgy Bela Halmos; Victor Guryev; Peter Laszlo Horvatovich; Ed Schuuring; Bernardus Franciscus Augustinus Maria van der Laan; Bert van der Vegt; Boudewijn Evert Christiaan Plaat; Cornelia Johanna Verhoeven Journal: Cell Oncol (Dordr) Date: 2022-01-11 Impact factor: 6.730
Authors: Melina J Windon; Gypsyamber D'Souza; Farhoud Faraji; Tanya Troy; Wayne M Koch; Christine G Gourin; Ana P Kiess; Karen T Pitman; David W Eisele; Carole Fakhry Journal: Cancer Date: 2019-01-15 Impact factor: 6.860
Authors: Carole Fakhry; Tim Waterboer; William H Westra; Lisa M Rooper; Melina Windon; Tanya Troy; Wayne Koch; Christine G Gourin; Noemi Bender; Siddhartha Yavvari; Ana P Kiess; Brett A Miles; William R Ryan; Patrick K Ha; David W Eisele; Gypsyamber D'Souza Journal: Oral Oncol Date: 2019-12-24 Impact factor: 5.337
Authors: Julie A Kish; Qiang Zhang; Corey J Langer; Phuc Felix Nguyen-Tân; David I Rosenthal; Randal S Weber; Marcy A List; Stuart J Wong; Adam S Garden; Kenneth Hu; Andy M Trotti; James A Bonner; Christopher U Jones; Sue S Yom; Wade Thorstad; Christopher J Schultz; John A Ridge; George Shenouda; Jonathan Harris; Quynh-Thu Le Journal: J Geriatr Oncol Date: 2021-04-02 Impact factor: 3.929