Prognostic factors are important for treatment decisions as they help adapt the
therapy on a case-to-case basis. Nodal status, number of positive nodes, and presence of extracapsular spread are considered to be the important prognostic factors in
head and neck cancer. Some studies suggest that human papillomavirus (HPV) status also influences the outcome of the treatment. This influence can be explained by the variation in tendency to develop regional
metastases and by variation in the type of neck node involvement. The study objectives were to compare patients with HPV positive and HPV-negative
tumors for survival and prevalence and type of regional
metastasis, to identify prognostic factors and to test whether HPV presence is an independent factor of survival. The study included 81 patients treated by surgery including
neck dissection for oral or oropharyngeal
squamous cell cancer. A computerized medical report was completed for each patient. Analysis of the
tumor specimen for the HPV
DNA presence was done on
paraffin-fixed tissue. HPV
DNA detection and typing were performed by PCR with GP5+/GP6+BIO primers and reverse line blot hybridization. Overall, 64% (52/81) of
tumors were HPV positive with 80% in the tonsillar site. HPV-positive patients had significantly better both overall (73 vs. 35%) (P=0.0112) and disease-specific (79 vs. 45%) (P=0.0015) survival rates than HPV-negative patients. No significant differences were found in the pN classification, in the number of positive nodes and the presence of extracapsular spread in the involved nodes between HPV positive and HPV-negative
tumors. Multivariate analysis showed that significant prognostic factors of survival were the presence of HPV in the
tumor, extracapsular spread and
tumor size. HPV was the most significant prognostic factor in the studied group of patients with oropharyngeal
tumors (HR=0.27, 95%CI 0.12-0.61) and possibly should be considered in treatment decisions.