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Prognostic impact of HPV-associated p16-expression and smoking status on outcomes following radiotherapy for oropharyngeal cancer: the MARCH-HPV project
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2018 (English)In: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 126, no 1, p. 107-115Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Evaluate the prognostic and predictive impact of HPV-associated p16 -expression and assess the combined prognostic impact of p16 and smoking on altered fractionated radiotherapy (AFRT) for oropharyngeal cancer (OPC) within the frames of the update of the Meta-Analysis of Radiotherapy in Carcinomas of Head and neck (MARCH). Materials and methods: Patients with OPC, known tumor p16-status and smoking history were identified from the MARCH update, resulting in a dataset of 815 patients from four randomized trials (RTOG9003, DAHANCA6&7, RTOG0129, ARTSCAN). Analysis was performed using a Cox model stratified by trial and adjusted on gender, age, T-stage, N-stage, type of radiotherapy fractionation, p16, smoking. Primary end-point was progression-free survival (PFS). Results: In total, 465 patients (57%) had p16-positive tumors and 350 (43%) p16-negative. Compared to p16-negative, p16-positive patients had significantly better PFS (HR = 0.42 [95% CI: 0.34-0.51], 28.9% absolute increase at 10 years) and OS (HR = 0.40 [0.32-0.49], 32.1% absolute increase at 10 years). No interaction between p16-status and fractionation schedule was detected. Smoking negatively impacted outcome; in the p16-positive subgroup, never smokers had significantly better PFS than former/current smokers (HR = 0.49 [0.33-0.75], 24.2% survival benefit at 10 years). Conclusions: No predictive impact of p16-status on response to AFRT could be detected but the strong prognostic impact of p16-status was confirmed and especially p16-positive never smoking patients have superior outcome after RT. 

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD , 2018. Vol. 126, no 1, p. 107-115
Keyword [en]
FIPV, Smoking, Oropharynx carcinoma, Prognostic, Radiotherapy, Altered fractionation
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-145808DOI: 10.1016/j.radonc.2017.10.018ISI: 000425578100014PubMedID: 29100700OAI: oai:DiVA.org:umu-145808DiVA, id: diva2:1192423
Conference
15th International Wolfsberg Meeting on Molecular Radiation Biology/Oncology, JUN 17-19, 2017, SWITZERLAND
Available from: 2018-03-22 Created: 2018-03-22 Last updated: 2018-06-09Bibliographically approved

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Zackrisson, Björn

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