From the Guidelines
Prognosis for HPV 16 Positive Tonsillar Squamous Cell Carcinoma
The prognosis for HPV 16 positive tonsillar squamous cell carcinoma with cervical lymph node and lung metastases is generally better compared to HPV-negative tumors, but still poor due to the presence of distant metastases.
Key Factors Influencing Prognosis
- HPV status: HPV-positive oropharyngeal cancer has a better prognosis compared to HPV-negative tumors 1.
- p16 status: p16-positive disease is associated with greater median survival in recurrent or metastatic head and neck squamous cell carcinoma 1.
- Metastases: The presence of lung metastases indicates advanced disease and a poorer prognosis.
Treatment and Management
- Treatment de-escalation: Although HPV-positive oropharyngeal cancer has a better prognosis, treatment de-escalation is still investigational and not recommended outside of clinical trials 1.
- Immunotherapy: Pembrolizumab or nivolumab may be effective in patients with PD-L1-expressing tumors, but their use is primarily in the context of recurrent or metastatic disease 1.
Overall Prognosis
Given the presence of cervical lymph node and lung metastases, the overall prognosis for HPV 16 positive tonsillar squamous cell carcinoma is poor, despite the favorable impact of HPV positivity on prognosis.
- Median survival: The median survival for patients with recurrent or metastatic head and neck squamous cell carcinoma is around 6-12 months, with HPV-positive disease having a slightly better prognosis 1.
From the Research
Prognosis for HPV 16 Positive Tonsillar Squamous Cell Carcinoma
- The prognosis for HPV 16 positive tonsillar squamous cell carcinoma is generally better than for HPV-negative tumors, with roughly 80% vs. 50% 3-year disease-free survival, respectively 2.
- Patients with HPV-positive tonsillar cancer have better prognosis than those with HPV-negative tumors, and the former group could hypothetically benefit from reduced, less-toxic treatment without compromising survival 3.
- The presence of cervical lymph node metastases does not seem to affect the prognosis in HPV-positive tonsillar squamous cell carcinomas, as the N status is an unreliable prognostic indicator in these cases 4.
- Lung metastases are not specifically addressed in the provided studies, but it can be inferred that the prognosis for patients with distant metastases is generally poorer.
- HPV-positive tonsillar squamous cell carcinomas have unique clinicopathological and molecular biological features, showing better prognosis compared to HPV-negative TSCC, with 3-year and 5-year overall survival rates of 87.7% and 78.9%, respectively 5.
Treatment and Survival
- There were no significant differences in overall or disease-free survival between patients treated with conventional radiotherapy, accelerated radiotherapy, or chemoradiotherapy 3.
- However, there was a trend implying a beneficial effect of intensified treatment, with chemoradiotherapy being better than radiotherapy, despite more patients having stage IV disease in the former group 3.
- The value of HPV for prognosis of patients with TSCC requires further study, especially in relation to treatment modalities 4.
HPV Status and Prognosis
- HPV status is a significant prognostic indicator in tonsillar squamous cell carcinomas, with HPV-positive tumors having a better prognosis than HPV-negative tumors 2, 4, 5.
- The presence of HPV type 16 is associated with a better prognosis, and high-risk HPV-16 subtype accounts for 72.2% of HPV-positive TSCC cases 5.