HPV-Positive Sinonasal Squamous Cell Carcinoma May Be Associated with Improved OS

A study published in Cancer found that human papillomavirus (HPV)-positive sinonasal squamous cell carcinoma (SNSCC) was associated with improved overall survival (OS), highlighting the need for routine testing, which is recommended for patients with oropharyngeal tumors.

The researchers also indicated that, although only a small number of patients with SNSCC are tested for HPV, a sizable percentage of thesecases may be HPV related.

“We believe the findings of the current large, multicenter cohort of patients with SNSCC who were tested for HPV are provocative enough to warrant further investigation,” the authors wrote.

Using all SNSCC cases reported in the National Cancer Data Base between 2010 and 2016, the researchers identified a total of 6,458 SNSCC cases. The median patient age of those identified was 64 years, and the majority had advanced stage tumors, with 721 patients diagnosed as stage III-IV (62.1%). Of that cohort, only 1,523 cases (23.6%) were tested for HPV and included in this study. In toal, 447 patients with HPV-positive SNSCC (31.5%) were included in the final study cohort.

Across 15 hospitals that routinely tested non-oropharyngeal squamous cell carcinomas (OPSCCs) for HPV, the percentage of HPV-positive SNSCCs was less (24.6%; P = .04). Patients with HPV-positive SNSCC were found to be younger (aged 60 years vs 65 years; P < 0.001), with tumors that were more likely to be high grade (55.3% vs 41.7%; P < 0.001), and attributed to the nasal cavity (62.2% vs 44.0%; P < 0.001). Additionally, HPV-positive SNSCC was correlated with significantly improved OS in multivariable regression analyses (hazard ratio [HR], 0.45; 95% CI, 0.28-0.72; P = 0.001) and propensity score-matched (HR, 0.61; 95% CI, 0.38-0.96; P = .03) analyses controlled for clinicodemographic and treatment factors. 

“This may indicate that current testing practices have led to elevated rates of HPV-positive tumor detection due to a selection bias,” the authors wrote. “In addition, it could explain why previously reported rates of HPV-positive SNSCC, for the most part, have been higher than the incidence we observed (20%-62%).”

Some of the differences in HPV-associated survival could be attributed to differences in management practices. Compared to those with HPV-negative tumors, patients with HPV-positive OPSCC repeatedly have been shown to have higher response rates to radiotherapy and chemotherapy. However, the 2 most common treatment regimens used in the SNSCC cohort within this study were unimodality surgery and surgery with adjuvant radiotherapy. Moreover, in the survival analysis performed, researchers found that surgery with adjuvant therapy was correlated with a significantly larger improvement in OS in patients with HPV-positive SNSCC compared to those with HPV-negative SNSCC.

Previous studies of HPV-positive OPSCC have shown that primary surgical treatment can produce equivalent, if not superior, outcomes when compared with primary chemoradiotherapy. When referencing SNSCC though, the researchers noted that determining the role of surgery and the impact of adjuvant therapy are more difficult to investigate given the lower incidence of the disease; though these topics are worth investigating further in the future.

According to the study, squamous cell carcinoma accounts for approximately 60% to 75% of sinonasal malignancies, however SNSCC is rare overall, representing <3% of all head and neck cancers. SNSCC generally presents at an advanced stage though, and the prognosis for patients with SNSCC is generally poor, with 5-year survival rates of 54% to 60%. 

Reference:

Oliver JR, Lieberman SM, Tam MM, et al. Human Papillomavirus and Survival of Patients with Sinonasal Squamous Cell Carcinoma. Cancer. doi:10.1002/cncr.32679.