SP49. Surgical Management of Advanced Squamous Cell Carcinoma of the Head and Neck in HPV+ Patients

PURPOSE: The increasing incidence of human papillomavirus (HPV)-associated head and neck cancer (HNC) necessitates studies on patient outcomes and survival stratified by HPV status. Many studies have assessed HPV-associated survival across all HNC patients. In this study, we compare of survival by HPV status for patients with advanced HNC to inform surgical management in this growing patient population. METHODS: Adults with malignant squamous cell HNC diagnosed between 2011 and 2017 were identified from the Surveillance, Epidemiology and End Results (SEER) Head and Neck with HPV status database, which includes data from registries covering 47% of the United States population. Patients without HPV status, survival data or histopathologic confirmation of disease were excluded. “Invasive” carcinoma was defined as cancers with T4 staging, as this denotes bone involvement. Kaplan-Meier survival analyses were completed in R Studio (v1. 3.1). RESULTS: The analysis of survival by HPV status and tumor invasiveness included 13,493 patients; of these, 9,087 had HPV-associated disease and 1,564 had invasive disease. Survival analysis of HPV-associated disease versus non-HPV associated disease across all patients revealed significantly higher 8-year survival for patients with HPV-associated disease than those without (p < 0.01), consistent with recent literature. No HPV-associated survival difference was found when the patient population was narrowed to patients with T4 disease. CONCLUSION: HPV-associated HNC is often considered less severe than non-HPV-associated disease which may lead to more conservative management decisions. However, this first of its kind analysis of HNC subgroups demonstrates the absence of any HPV-associated survival benefit among patients with advanced disease involving the bone. These data suggest that such cancers should be managed with aggressive surgical resection and reconstruction, consistent with management of non-HPV-associated etiologies.