Sex-based differences in outcomes of patients with HPV-positive versus HPV-negative oropharyngeal carcinoma: a population-based study

Objectives Prior studies have suggested that female sex is predictive of poor outcomes among patients with oropharyngeal carcinoma. The current study aims at elucidating whether this observation applies to both HPV-positive and HPV-negative subsets of the disease. Methods Surveillance, Epidemiology and End Results (SEER) - HPV specialized database was accessed. Cases with oropharyngeal squamous cell carcinoma and known HPV status were reviewed. Multivariable logistic regression analysis was used to evaluate factors predicting HPV positive status. The relationship between sex and overall and cancer-specific survival was further evaluated through multivariable Cox regression analysis. Results Female sex was associated with less probability of HPV positive status (OR: 0.55; 95% CI: 0.50-0.61; P<0.01). Using multivariable Cox regression analysis and among patients with HPV-negative disease, female patients have worse overall survival (HR: 1.24; 95% CI: 1.12-1.39; P<0.01) and cancer-specific survival (HR: 1.27; 95% CI: 1.08-1.50; P<0.01); while among patients with HPV-positive disease, there was no difference between males and females with regards to overall survival (HR: 1.05; 95% CI: 0.91-1.21; P= 0.45) or cancer-specific survival (HR: 1.17; 95% CI: 0.95-1.45; P= 0.12). Conclusions Among patients with HPV-positive oropharyngeal carcinoma, there is no difference in survival outcomes between women and men; while among patients with HPV-negative oropharyngeal carcinoma, women have worse survival outcomes compared to men.