Prognostic relevance of human papillomavirus infection in anal squamous cell carcinoma: Analysis of the national cancer data base

• Type of Material: Article
• Authors: Jaymin Jhaveri, Emory University; Lael Rayfield, Emory University; Yuan Liu, Emory University; Mudit Chowdhary, Rush University; Richard J. Cassidy, Emory University; Nicholas A. Madden, Emory University; Daniel G. Tanenbaum, Emory University; Theresa Wicklin Gillespie, Emory University; Pretesh Patel, Emory University; Kirtesh Patel, Emory University; Jerome C Landry, Emory University
• Language: English
• Date: 2017-12-01
• Publisher: Society for Gastrointestinal Oncology
• Publication Version: Final Published Version
• Copyright Statement: © Journal of Gastrointestinal Oncology.
• Final Published Version (URL): http://dx.doi.org/10.21037/jgo.2017.10.05
• Title of Journal or Parent Work: Journal of gastrointestinal oncology
• ISSN: 2078-6891
• Volume: 8
• Issue: 6
• Start Page: 998
• End Page: 1008
• Grant/Funding Information: Funding: Research reported in this publication was supported in part by the Biostatistics and Bioinformatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI award number P30CA138292.
• Keywords: anal cancer; overall survival (OS); National Cancer Database (NCDB); gender; squamous cell carcinoma; Human papillomavirus (HPV)
• Research Categories: Health Sciences, Radiology; Health Sciences, Oncology; Biology, Bioinformatics

Abstract

Background: To examine the prognostic relevance of human papillomavirus (HPV) infection for anal squamous cell carcinoma (ASCC) patients treated with chemoradiation (CRT) in the National Cancer Data Base (NCDB). Methods: The 2014 NCDB was queried for non-metastatic, histologically confirmed, ASCC patients diagnosed between 2004 and 2013. Patients were required to have HPV status documented in order to be eligible. Patients were then stratified into two groups: HPV+ and HPV-. Univariate analysis (UVA) was performed using the χ 2 test for categorical covariates and ANOVA for numerical covariates. Multivariable analysis (MVA) was performed using Cox proportional hazard model for overall survival (OS). Hazard ratios (HRs) and 95% confidence intervals (CIs) were generated for each covariate. To minimize selection bias, propensity score (PS) weighting was implemented to balance OS related variables between the groups including: age, education level, stage, diagnosis year, insurance type, and agent of chemotherapy. Results: A total of 1,063 patients were eligible. Patients were stratified into HPV+ (n=498, 46.8%) and HPV- (n=565, 53.2%). After PS weighting, MVA for OS showed that for men, HPV infection was associated with better OS (HR: 0.60, 95% CI: 0.38-0.96; P=0.034). However, for women, HPV infection did not significantly influence survival (HR: 1.47, 95% CI: 0.96-2.25; P=0.074). Conclusions: To our knowledge, this is the largest patient series evaluating the impact of HPV infection on OS in patients with anal cancer. We found that HPV infection is associated with a statistically significant better survival for men with ASCC. In contrast, for women, HPV infection did not significantly influence survival.