Patients diagnosed with human papillomavirus (HPV)-negative oropharynx head and neck cancer had higher rates of cancer-specific mortality, all-cause mortality, second-cancer mortality, and competing-cause mortality compared with patients with HPV-positive disease, according to a new study.1

“To the best of our knowledge, this is the first population-based study to assess causes of early mortality stratified by HPV status among patients with OPC [oropharynx cancer] in the United States,” the researchers wrote. “These findings provide data to individualize risk profiles for specific early mortality events and survivorship screening for second malignancies.”

In the study, researchers used data from the Surveillance, Epidemiology, and End Results (SEER) database that included HPV status. The study included 4930 patients with oropharynx cancer diagnosed with nonmetastatic disease between 2013 and 2014; 72.2% had HPV-positive disease.

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Two-year cumulative all-cause mortality was lower in patients with HPV-positive disease compared with HPV-negative disease (10.4% vs 33.3%; P < .0001). These rates included lower rates of head and neck cancer-specific mortality (4.8% vs 16.3%, respectively; P <.0001) and competing-cause mortality (5.6% vs 17.0%; P <.0001).

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Additionally, patients with HPV-negative disease had higher rate of mortality from second primary malignancies compared with HPV-positive disease (63.5% vs 42.9%). Those with HPV-positive disease also had lower rates of cardiovascular death, chronic obstructive pulmonary disease, pneumonia, and chronic liver disease, all of which underscore “the importance of smoking-cessation counseling and lung cancer screening for HPV-negative patients.”

“Patients with HPV-positive and HPV-negative OPC are distinct populations with significantly different risks of both HNC-specific and competing-cause mortalities,” the researchers wrote. “Effective identification of risk factors for competing second-cancer and noncancer mortality can also inform medical management and survivorship screening for patients with OPC.”

Disclosure: Some of the authors reported financial relationships with pharmaceutical or medical device companies. For a full list of disclosures, please refer to the original study.


Fullerton ZH, Butler SS, Mahal BA, et al. Short-term mortality risks among patients with oropharynx cancer by human papillomavirus status [published online January 13, 2020]. Cancer. doi: 10.1002/cncr.32652