Does immune response to human papillomavirus (HPV) E6 and E7 proteins predict patient outcomes for head and neck cancer?
Using a large, population-based study of patients with head and neck cancer, we investigated the relationship between patient titers for HPV E6 and E7 proteins at the time of diagnosis and patient survival. Any positive seroresponse, irrespective of level, was associated with a significantly improved outcome for all forms of head and neck cancer (oropharyngeal, oral cavity, and larynx.
Seropositivity to HPV E6 and E7 proteins may be a useful alternative or adjunct to pathology-based testing for HPV in head and neck cancers, particularly for tumors outside of the oropharynx.
Pathology-based measures of human papillomavirus (HPV) status are routinely obtained in the care of head and neck cancer and are clearly associated with patient outcome for cancers of the oropharynx. However, it is unclear if HPV status is of high value for cancers of the larynx and oral cavity. In addition, it is possible to assess HPV infection using serology-based methods; however, the suitability of this pathology-independent measure for predicting patient outcome in head and neck cancer is unknown.
To investigate whether immunologic response to HPV16 is associated with patient survival across anatomic sites, independent of smoking and drinking history.
Design, Setting, and Participants
This was a population-based study of 1054 patients with head and neck cancer in the greater Boston, Massachusetts, area (1999-2003, 2006-2011).
Main Outcomes and Measures
All-cause survival in relation to HPV16 E6 and E7 seropositivity.
The 1054 patients reflected the demographics of those treated in this timeframe (75% male; mean age, 59 years). Seropositivity was very strongly associated with improved survival overall (hazard ratio HR], 0.33; 95% CI, 0.24-0.45; P < .001), with no evidence that the magnitude of immune response, as assessed by titer levels, effected outcome. Seropositivity was associated with improved patient survival across all head and neck cancer sites: HR for oropharynx cancer, 0.26; 95% CI, 0.18-0.39; for oral cavity cancer, 0.45; 95% CI, 0.18-0.80; and for larynx cancer, 0.29; 95% CI, 0.10-0.85. In addition, the associations with seropositivity were similar across smoking and/or drinking exposure groups: HRfor low exposure, 0.52; 95% CI, 0.20-1.36; for moderate exposure, 0.42; 95% CI, 0.25-0.70; for heavy exposure, 0.51; 95% CI, 0.36-0.73. In a subset of 162 patients with both HPV serology and p16 immunohistochemical (IHC) measures available, both measures were similarly associated with survival in the oropharynx (HR for serology, 0.16; 95% CI, 0.03-0.47; for p16 measures, 0.16; 95% CI, 0.03-0.46), whereas only serology was associated with outcome when considering all head and neck cancer cases (HR for serology,0.49; 95% CI, 0.23-1.04; for p16, 0.65; 95% CI, 0.30-1.42).
Conclusions and Relevance
Collectively, these data suggest that a positive serologic response to HPV16 oncoproteins may be the best approach to assess HPV-disease for clinical outcome because it is associated with survival for all types of disease and is a marker that is not dependent on pathology material.
Heather H. Nelson, Michael Pawlita, Dominique S. Michaud, Michael McClean, Scott M. Langevin, Melissa N. Eliot, Karl T. Kelsey. Immune Response to HPV16 E6 and E7 Proteins and Patient Outcomes in Head and Neck Cancer. JAMA Oncol. 2017;3(2):178–185. doi:10.1001/jamaoncol.2016.4500