Clinical profile and pattern of second primary tumors in HPV-positive and HPV-negative oropharyngeal cancer.

OBJECTIVES: To evaluate the clinical-epidemiological profile of patients with oropharyngeal cancer (OPC) positive for human papillomavirus (HPV+) and negative for human papillomavirus (HPV-), and to compare differences in the development of second primary tumors (SPT). METHODS: Retrospective cohort with patients diagnosed with OPC. Sociodemographic/clinical data, p16-status, alcohol/tobacco consumption were extracted. Absolute/relative frequencies, odds ratios (OR), prevalence of HPV and SPT were calculated. RESULTS: Of 538 patients with OPC, 59.8% (n=322) were HPV+; 40.2% (n=216) HPV-. The prevalence of SPTs was higher among HPV- (21.8%; n=47) than HPV+ (13.0%; n=42). Non-smokers were 4.5 times more likely to have HPV+ OPC (OR 4.58; confidence interval - CI 2.48-8.67), and non-drinkers were 2.06 times more likely (OR=2.06; CI 1.15-3.72). Nodal involvement was associated with a 2.77-fold higher likelihood of HPV+ (OR 2.77; CI 1.70-4.56); lymphoepithelial topographies with a 2.13-fold higher likelihood (OR 2.13; CI 1.37-3.31). SPTs occurred most in the skin (17.3%, n=9) and penis/prostate (15.4%, n=8) in HPV+, whereas in HPV- in head and neck (36.2%, n=22) and respiratory tract (18.0%, n=11). The interval between OPC diagnosis and SPT diagnosis was shorter in the HPV+ (median: 40 months). CONCLUSION: SPT pattern in OPC is not equal across HPV-groups. HPV- showed a higher prevalence of SPTs, more often involving the head and neck/respiratory tract, which may reflect the cumulative effect of tobacco/alcohol exposure. In HPV+, the lower SPT prevalence and different tumor distribution may indicate a more limited field cancerization effect. The shorter time to SPT diagnosis in HPV+ suggests that surveillance strategies may need to consider distinct risk profiles according to HPV-status.