einstein (São Paulo). 19/ago/2025;23:eAO1525.

Overall and disease-free survival in patients with HPV-positive and HPV-negative oropharyngeal cancer

Matheus de

Abreu

, Dandara Menezes de Araujo

Oliveira

, Bartolomeu Conceição Bastos

Neto

, Janaina Naiara

Germano

, Luiz Paulo

Kowalski

, Maria Paula

Curado

DOI: 10.31744/einstein_journal/2025AO1525

Highlights

■ HPV+ is associated with improved overall survival in oropharyngeal cancer
■ HPV+ tumors tend to recur earlier than HPV- tumors.
■ Metastasis is a key prognostic factor for mortality and recurrence regardless of HPV status.
■ Smoking and alcohol consumption reduce the favorable prognosis of HPV+.

ABSTRACT

Objective:

To analyze the overall and disease-free survival of patients with oropharyngeal squamous cell carcinoma.

Methods:

Sociodemographic and clinical data, HPV status, and alcohol/tobacco consumption were assessed among patients treated at AC Camargo Cancer Center, São Paulo, Brazil. Absolute and relative frequencies, overall survival, and disease-free survival at 5 and 7 years were calculated using Kaplan-Meier analysis, and Cox regression was used to estimate the risk of death.

Results:

The 7-year overall survival rate was 61.6% for patients with oropharyngeal squamous cell carcinoma (67.5% for HPV-positive cases and 51.1% for HPV-negative cases). Among HPV-positive cases, the risk of death was 5.29-fold higher for smokers than that for non-smokers (p<0.001) and 4.42-fold higher for patients with metastasis than that for those without (p=0.108). Among HPV-cases, those with clinical stage T3/T4 disease had a 1.8-fold higher risk of death than those with T1/T2 disease (p=0.039), and those with metastasis exhibited a 4.62-fold higher risk than those without (p<0.001). The 7-year disease-free survival rate for oropharyngeal squamous cell carcinoma was 88.6% (90.1% for HPV-positive cases and 85.9% for HPV-negative cases). Among HPV-positive cases, patients with metastasis had an 11.75-fold higher risk of recurrence than those without (p<0.001); among HPV-negative cases, patients with metastasis had a 4.62-fold higher risk than those without (p=0.004).

Conclusion:

Patients with HPV-positive oropharyngeal squamous cell carcinoma had higher overall survival and increased recurrence rates within the first 3 years but lower recurrence rates beyond 5 years than patients with HPV-negative disease. More frequent follow-ups after 5 years are recommended for patients with HPV-positive disease. Tobacco and alcohol consumption negatively affect the overall survival of patients with HPV-positive oropharyngeal squamous cell carcinoma.

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