Prognostic Factors (Including HPV Status) for Irradiation of Locally Advanced Squamous Cell Carcinoma of the Head and Neck (SCCHN)

Background and Purpose: The prognosis of patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) is generally poor. However, prognostic factors can help optimize the care for the individual patient. This study investigated potential prognostic factors, including HPV status, for locoregional control (LRC), metastases-free survival (MFS), and survival (OS). Patients and Methods: Twelve potential prognostic factors were investigated in 170 patients irradiated for stage III or IV SCCHN, including age (5 60 vs > 60 years), gender, ECOG performance score (0-1 vs 2), preradiotherapy hemoglobin level (<12 vs >= 12 g/dl), tumor site (oropharynx, oral cavity, hypopharynx, or larynx), histological grade (G1-2 vs G3),T category (T1-T2 vs T3-T4), N category (N0-N1 vs N2-N3), AJCC stage (III vs IV), surgery (no vs yes), and chemotherapy (no vs yes). Results: On multivariate analysis, positive HPV status (RR 2.34; p = 0.014), ECOG performance score 0-1 (RR 1.94; p = 0.017), preRT hemoglobin >= 12 g/dl (RR 1.88; p = 0.018),T category T1-T2 (RR 2.72; p < 0.001), and surgery (RR 2.29; p = 0.007) were significantly associated with improved LRC. PreRT hemoglobin >= 12 g/dl (RR 1.98; p = 0.040) and T category T1-T2 (RR 3.33; p < 0.001) were significantly associated with improved MFS. Positive HPV status (RR 2.19; p = 0.019), pre-RT hemoglobin >= 12 g/dl (RR 2.15; p = 0.002), T category T1-T2 (RR 2.31; p = 0.002), and AJCC stage III (RR 1.91; p = 0.034) were significantly associated with improved OS. Conclusion: Improved treatment outcomes were significantly associated with positive HPV status, better performance status, lower tumor stage, and pretreatment hemoglobin levels >= 12 g/dl. These factors should be considered in future trials.