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Background <p>Human papillomavirus (HPV) has emerged as a major cause of head and neck cancer (HNC), yet nationwide HPV-stratified disease data are still lacking in China. The literature remains divided on the prognostic impact of HPV infection.</p> Methods <p>The HNC patients treated from 1 January 2017 to 30 June 2021 were retrospectively identified at nine tertiary A centers representing the seven geographic regions of China. Event-free survival (EFS) and cancer-specific survival (CSS) were estimated with the Kaplan-Meier method and compared using the log-rank test. Early survival differences by subsite and HPV status were assessed using restricted mean survival time differences for EFS (ΔRMEFST) and CSS (ΔRMCSST), adjusting for confounders with pseudo-value regression.</p> Results <p>The study included 345 cases. Most of the Chinese HNC patients in this study were male (84.64%), and more than one-third were already at clinical Tumor-Node-Metastasis (cTNM) stage IV at diagnosis. Among the 237 patients who underwent HPV testing, 18.99% were HPV-positive, with the highest prevalence in oropharyngeal cancers (37.29%) and the lowest in laryngeal cancers (7.48%; <i>p</i> &lt; 0.001). A higher proportion of HPV‑positive patients consumed alcohol (44.44%), received radiotherapy (53.33%) and chemotherapy (88.89%), whereas a lower proportion underwent surgery (62.22%) (all <i>p</i> &lt; 0.001). In oral cancer, EFS was higher in the HPV-positive group (log-rank <i>p</i> = 0.002); after adjustment for confounders, the 12-month ΔRMEFST was 1.576 months (95%CI = 0.157, 2.996; <i>p</i> = 0.029). Among patients with oropharyngeal cancer, both EFS and CSS were higher in the HPV-positive group than in the HPV-negative group (all log-rank <i>p</i> &lt; 0.050). After multivariable adjustment, the 12-month ΔRMCSST was 0.629 months (95%CI = 0.019, 1.238; <i>p</i> = 0.043). Laryngeal cancer patients showed no HPV-related differences in EFS or CSS (all <i>p</i> &gt; 0.050). A 24-month landmark sensitivity analysis confirmed the survival advantage in oral and oropharyngeal cancer.</p> Conclusions <p>Demographics, risk profiles, presentation, and treatment patterns differ sharply by HPV status. Early survival is better for HPV-positive oral and oropharyngeal cancers but not for laryngeal cancer.</p>

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Clinical characteristics and prognostic impact of HPV infection in head and neck cancer patients in China: a nationwide multicenter study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年7月18日

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  • Qi-Jian Zheng,
  • Hong-Hao Wang,
  • Chao Ding,
  • Guang Han,
  • Li Li,
  • Xiao-Li Cui,
  • Shao-Kai Zhang,
  • Hong-Ying Yang,
  • Yan Wang,
  • Yong-Zhen Zhang,
  • Wen-Jun Wang,
  • Yu-Ting Hong,
  • Mei-Wen Yuan,
  • Xue-Lian Zhao,
  • Shang-Ying Hu,
  • Jun-Ling Wang,
  • Fang-Hui Zhao

摘要

Background

Human papillomavirus (HPV) has emerged as a major cause of head and neck cancer (HNC), yet nationwide HPV-stratified disease data are still lacking in China. The literature remains divided on the prognostic impact of HPV infection.

Methods

The HNC patients treated from 1 January 2017 to 30 June 2021 were retrospectively identified at nine tertiary A centers representing the seven geographic regions of China. Event-free survival (EFS) and cancer-specific survival (CSS) were estimated with the Kaplan-Meier method and compared using the log-rank test. Early survival differences by subsite and HPV status were assessed using restricted mean survival time differences for EFS (ΔRMEFST) and CSS (ΔRMCSST), adjusting for confounders with pseudo-value regression.

Results

The study included 345 cases. Most of the Chinese HNC patients in this study were male (84.64%), and more than one-third were already at clinical Tumor-Node-Metastasis (cTNM) stage IV at diagnosis. Among the 237 patients who underwent HPV testing, 18.99% were HPV-positive, with the highest prevalence in oropharyngeal cancers (37.29%) and the lowest in laryngeal cancers (7.48%; p < 0.001). A higher proportion of HPV‑positive patients consumed alcohol (44.44%), received radiotherapy (53.33%) and chemotherapy (88.89%), whereas a lower proportion underwent surgery (62.22%) (all p < 0.001). In oral cancer, EFS was higher in the HPV-positive group (log-rank p = 0.002); after adjustment for confounders, the 12-month ΔRMEFST was 1.576 months (95%CI = 0.157, 2.996; p = 0.029). Among patients with oropharyngeal cancer, both EFS and CSS were higher in the HPV-positive group than in the HPV-negative group (all log-rank p < 0.050). After multivariable adjustment, the 12-month ΔRMCSST was 0.629 months (95%CI = 0.019, 1.238; p = 0.043). Laryngeal cancer patients showed no HPV-related differences in EFS or CSS (all p > 0.050). A 24-month landmark sensitivity analysis confirmed the survival advantage in oral and oropharyngeal cancer.

Conclusions

Demographics, risk profiles, presentation, and treatment patterns differ sharply by HPV status. Early survival is better for HPV-positive oral and oropharyngeal cancers but not for laryngeal cancer.