HPV-16 Is A Promising Prognostic Indicator For Oropharyngeal Squamous Cell Carcinoma

Combining salivary and plasma human papillomavirus type 16 status improves the prognostic value of the test in patients with oropharyngeal squamous cell carcinoma

medwireNews: Detection of human papillomavirus type 16 (HPV-16) oncoproteins E6 and E7 in saliva and plasma samples may help to predict tumour status and recurrence in patients with oropharyngeal squamous cell carcinoma, preliminary study findings show.

Combining quantitative polymerase chain reaction results for patients’ pretreatment saliva and plasma samples was more accurate than using either result alone; if either was positive the sensitivity for tumour HPV-16 status was 76.1%, compared with 67.3% for a positive plasma result and 52.8% for a positive saliva result. Specificity was 100% for both individual and combined results.

There were 93 patients in the retrospective study, of whom 81 had tumours that were positive for HPV-16. Those with positive tumours tended to be non-smokers and had more lymph node involvement than patients who were HPV-16 negative (89 vs 58% with N2/N3 disease).

During a median follow-up of 49 months, 14 patients with HPV-16–positive tumours developed recurrence, as did five patients with negative tumours. Positive HPV-16 status of post-treatment saliva or plasma samples was 69.5% sensitive and 90.7% specific for tumour recurrence within 3 years.

Again, the researchers obtained greater accuracy using the combined results than only the saliva results (18.8% sensitive; 96.6% specific) or only the plasma results (55.1% sensitive; 95.6% specific), they report in JAMA Otolaryngology - Head & Neck Surgery.

“There is a window of opportunity in the year after initial therapy to take an aggressive approach to spotting recurrences and intensively addressing them while they are still highly treatable,” commented study author Joseph Califano, from Johns Hopkins Medical Institutions, Baltimore, Maryland, USA, in a press statement.

“Until now, there has been no reliable biological way to identify which patients are at higher risk for recurrence, so these tests should greatly help do so.”

Indeed, after accounting for variables including smoking status and N classification, patients who had a positive post-treatment saliva or plasma sample were 24.4-fold more likely to have recurrence than patients whose samples were both negative, and they were 21.2-fold more likely to die (eight HPV-16–positive patients died, five from their cancer).

Of note, one patient with false-negative pretreatment results for both saliva and plasma samples had a positive post-treatment plasma sample, 7 months before recurrent disease was detected.

This suggests that “a plasma-based surveillance test may potentially still be used to monitor for recurrence in patients with HPV-16–positive tumor even if pretreatment screening test was not able to detect HPV-16 DNA”, says the team.


Ahn SM, Chan JYK, Zhang Z, et al. Saliva and Plasma Quantitative Polymerase Chain Reaction–Based Detection and Surveillance of Human Papillomavirus–Related Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2014. Online first July 31. doi:10.1001/jamaoto.2014.1338

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