HPV ‐Positive Keratinizing Nasopharyngeal Carcinoma Is Associated With Better Survival: A NCDB Study

OBJECTIVES: To investigate the prognostic relevance of human papillomavirus (HPV) in nasopharyngeal carcinoma (NPC). METHODS: The National Cancer Data Base (NCDB) was used to query patients with NPC and available HPV testing data between 2010 and 2017. Logistic regression was performed to predict factors associated with HPV testing and HPV positivity. Overall survival (OS) was evaluated using Kaplan Meier analysis between HPV-positive versus HPV-negative cohorts. Univariate and multivariate analyses using Cox proportional hazards modeling were performed to assess for factors associated with OS. RESULTS: Among our cohort of 5081 patients, 3177 (62.5%) underwent HPV testing. Kaplan Meier analysis revealed improved OS among HPV-positive patients with keratinizing subtype of NPC (log rank p < 0.001). No differences in OS were observed in patients with other histologic subtypes of NPC. On multivariate analysis of the keratinizing SCC cohort, HPV positivity was associated better OS after controlling for sex, age, race, insurance status, facility volume, facility type, zip code level education, Charlson comorbidity score, staging, and treatment (HR 0.81, 95% CI: 0.70-0.94, p = 0.006). CONCLUSION: HPV status was independently associated with improved OS among patients with keratinizing subtype of NPC. Incorporation of HPV testing may be warranted in the workup of NPC.