Background:
Head and neck squamous cell carcinoma (HNSCC) represents a complex group of malignancies originating from the mucosal linings of the upper aerodigestive tract. Despite therapeutic advancements, HNSCC is associated with high recurrence rates, morbidity, and mortality. The p16 (HPV) status has emerged as a potential prognostic marker, with HPV-positive tumours exhibiting distinct clinical characteristics and outcomes compared to HPV-negative counterparts. This study aims to investigate the impact of p16 status on HNSCC behaviour in patients with oropharyngeal SCC.
Methods:
This retrospective cohort study included patients with primary stages I-III oropharyngeal SCC treated at the Illawarra and Shoalhaven Cancer Care Centres from 2013 to April 2024. Data was collected from electronic medical records, including demographic information, smoking status, clinical characteristics (tumour site, stage), treatment modalities, p16 status, and recurrence status (location, time to recurrence). Inclusion criteria encompassed patients with stage I-III oropharyngeal SCC treated with curative intent and known p16 status.
Results:
Two-hundred and thirty-seven patients with oropharyngeal cancer were identified. Median duration of follow up was 45 months. Most patients were p16 positive (n=199, 84.0%). Most patients (84.0%) were treated with primary radiotherapy or chemoradiotherapy, with 16.0% undergoing primary surgery with or without adjuvant chemo/radiotherapy. Forty-one patients (17.3%) had recurrent disease. p16 status was not associated with disease free survival (log rank p=0.81), risk of locoregional recurrence (p=0.84) or risk of distant failure (p=0.68). p16 negative patients recurred sooner, with all recurrences occurring within 2yrs, while p16 positive patients developed recurrent disease beyond 5 years of follow up.
Conclusion:
p16 status was not associated with risk of relapse or site of recurrent disease, but those with p16 positive disease demonstrated a more prolonged duration of risk of recurrence, this suggests follow up protocols may be tailored by p16 status.