Human Papillomavirus among Veterans Treated for Oropharyngeal Squamous Cell Carcinoma

Objectives: The prevalence and significance of high-risk oral human papillomavirus (HPV) among veterans treated for oropharyngeal squamous cell carcinoma (OPSCC) remains unknown. In this study, we aimed to (1) define the prevalence of HPV among veterans with OPSCC and (2) compare outcomes of veterans with OPSCC relative to high-risk HPV status and other well-known prognostic factors. Methods: Patients from a high-volume Veterans Administra-tion (VA) medical center with OPSCC were identified from 2001-2006. Demographic, surgical, and pathological data were extracted from the electronic medical record. P16 immunohistochemistry testing was performed on archived pathological samples as a surrogate marker for HPV status. Outcomes were compared between HPV-positive (+) and negative (–) patients using Kaplan-Meier estimates. Results: Seventy-six veteran patients with available tumor tissue and follow-up data were included. All of the patients were male (100%) and the vast majority were ever smokers (89%). Most patients presented with advanced stage disease (61, 80%) and were treated nonsurgically (64, 84%). The overall prevalence of p16 positivity was 52 out of 76 (68%). Overall survival at 2 and 5 years was 60% and 38%, respectively, for the entire cohort. HPV+ veteran patients had significantly better survival at 2 years (58% vs 33%) and 5 years (40% vs 17%) than HPV– veteran patients (P = .014). Conclusions: Using p16 as a surrogate marker, HPV is prevalent among veteran patients treated for OPSCC. Veteran patients with HPV-associated OPSCC have improved survival relative to HPV-negative patients. However, their prognosis remains poor compared to a nonveteran population.