Incidence and Demographic Burden of HPV-associated Oropharyngeal Head and Neck Cancers in the United States
Menée à partir des données des registres américains des cancers portant sur 12 017 patients atteints d'un carcinome épidermoïde du pharynx (oropharynx, hypopharynx, rhinopharynx) diagnostiqué entre 2013 et 2014, cette étude analyse les facteurs associés à l'incidence du carcinome épidermoïde de l'oropharynx lié à une infection par le papilllomavirus humain, et la mortalité associée
Background: Human papillomavirus (HPV)-positive oropharyngeal head and neck squamous cell carcinoma (OPSCC) is increasing in the United States (US). Current epidemiologic assessments of the national burden of HPV-positive OPSCC are needed. Methods: The Surveillance, Epidemiology, and End Results (SEER) HPV Status Database included 12,017 patients with head and neck squamous cell carcinoma (HNSCC) of pharyngeal subsites including OPSCC and non-OPSCC HNSCC subsites (hypopharynx, nasopharynx, and 'other pharynx'), diagnosed from 2013-2014. Age-adjusted incidence rates per 100,000 persons by HPV status were calculated. An exploratory Fine-Gray competing-risks regression determined the associations between HPV-status and cancer-specific mortality (CSM). Results: From 2013-2014, the US incidence of HPV-positive OPSCC was 4.62 (95% Confidence Interval 4.51-4.73) versus 1.82 (1.75-1.89) per 100,000 persons for HPV-negative OPSCC. The incidence of HPV-positive versus negative non-OPSCC of the head and neck was 0.62 (0.58-0.66) versus 1.38 (1.32-1.44). White race (5.47) and male sex (8.00) had the highest incidences of HPV-positive OPSCC, with a unimodal age incidence distribution peaking at 60-64 (27.23). HPV-positivity was associated with lower cancer-specific mortality than HPV-negative disease for OPSCC (Adjusted Hazard Ratio [AHR] 0.40, P<0.001), but not non-OPSCC (AHR 1.08, P=0.81) Pinteraction=0.002. Conclusions: The US incidence of HPV-positive OPSCC was 4.61 per 100,000 persons. Most cases occurred in white male patients younger than 65, where it represents the sixth most common incident non-skin cancer. The favorable prognosis associated with HPV appears to be limited to the oropharynx. Impact: This large population-based epidemiological assessment of the US population defines the incidence and demographic burden of HPV-positive OPSCC.