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HPV Oropharyngeal Prognosis — SCE Medical Oncology MCQ

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EasyHead & Neck CancerHPV Oropharyngeal PrognosisSCE Medical Oncology

A 65-year-old man with HPV-positive (p16+) oropharyngeal SCC (T2 N1 M0) is treated with curative chemoradiotherapy. His prognosis is significantly better than a patient with identical staging but HPV-negative disease. What are the approximate 5-year OS rates for p16-positive versus p16-negative oropharyngeal SCC?

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Correct answer: E — HPV-positive: ~80-85% 5-year OS; HPV-negative: ~45-55% 5-year OS — HPV status is the strongest prognostic factor in oropharyngeal SCC

HPV/p16-positive oropharyngeal SCC has a dramatically better prognosis than HPV-negative disease (5-year OS approximately 80-85% vs 45-55%). This is reflected in the AJCC 8th edition TNM staging which has a separate staging system for p16-positive oropharyngeal cancer (downstaging compared with p16-negative). The better prognosis is attributed to intact immune surveillance, wild-type TP53, radiosensitivity and younger patient demographics. De-escalation trials are evaluating reduced-intensity treatment for favourable HPV-positive disease.

Reference: NICE NG36; ESMO 2024 H&N Cancer; AJCC 8th Edition; Ang et al NEJM 2010