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Wilson DD, Rahimi AS, Saylor DK, et al. p16 Not a Prognostic Marker for Hypopharyngeal Squamous Cell Carcinoma. Arch Otolaryngol Head Neck Surg. 2012;138(6):556–561. doi:10.1001/archoto.2012.950
Author Affiliations: Departments of Radiation Oncology (Drs Wilson and Read and Ms Saylor), Pathology (Dr Stelow), and Otolaryngology–Head and Neck Surgery (Drs Jameson, Shonka, Reibel, and Levine), University of Virginia, Charlottesville; Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas (Dr Rahimi).
Objective To investigate the prognostic significance of p16 in patients with hypopharyngeal squamous cell carcinoma (HPSCC) and to evaluate the relationship between p16 and human papillomavirus (HPV). Unlike in oropharyngeal SCC (OPSCC), the prognostic significance of p16 in HPSCC and its association with HPV is unclear.
Design Retrospective medical chart review.
Setting University tertiary referral center.
Patients A total of 27 patients with HPSCC treated with definitive radiation therapy between 2002 and 2011 whose tissue was available for immunohistochemical analysis.
Interventions Twenty-two patients were treated with chemoradiation, and 5 with radiation alone. All tumor biopsy specimens were analyzed for p16 and, when sufficient tissue was available, for HPV DNA.
Main Outcome Measures Overall survival (OS), locoregional control (LRC), disease-free survival (DFS), and laryngoesophageal dysfunction–free survival (LEDFS) were analyzed according to p16 status.
Results Findings for p16 were positive in 9 tumors and negative in 18 tumors. Median follow-up was 29.3 months. There was no significant difference in OS, LRC, DFS, or LEDFS for patients with p16-positive vs p16-negative tumors. Only 1 of the 19 tumors tested for HPV was found to be HPV positive. When used as a test for HPV, p16 had a positive predictive value of 17%.
Conclusions In contrast to OPSCC, p16 expression in patients with HPSCC had a low positive predictive value for HPV and did not predict improved OS, LRC, DFS, or LEDFS. Thus, for HPSCC, p16 is not a prognostic biomarker. Caution must be taken when extrapolating the prognostic significance of p16 in patients with OPSCC to patients with head and neck SCC of other subsites.
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