Predicting HPV status in head and neck cancer: The predictive value of sociodemographic and disease characteristics

Objective: To determine whether the human papillomavirus (HPV) status of head and neck squamous cell carcinomas (HNSCCs) can be reliably predicted based on sociodemographic and disease characteristics alone. Design : A retrospective medical chart review of clinical and pathologic features. Setting: Tertiary academic medical center. Patients: We studied patients treated for HNSCC who were tested for markers of HPV or had tissue available for testing between 2006 and 2010. Main Outcome Measures : Four otolaryngology-head and neck surgery trainees were given the database of patient clinical and pathologic features and asked to predict the HPV status for each patient. The trainees' responses were scored for accuracy, positive and negative predictive value, and interrater agreement. Multiple linear regression analyses were performed to determine predictors of HPV positivity. Results: A total of 174 patients meeting inclusion criteria were identified, 95 of whom were determined to have HPV-positive tumor tissue. Residents were able to accurately predict HPV status in 110 to 125 patients (63%-72%), with positive predictive values of 76% to 84% and negative predictive values of 61% to 69%. The only variables significantly related to HPV status were male sex (P =.01) and oropharyngeal subsite (P =.02). Only 4 patients had a "typical" HPV-positive profile. Conclusions: Knowledge of cancer stage, primary site, basaloid features, tumor differentiation, and presence of cystic neck disease and patient age, race, and smoking status did not allow accurate predictions of HPV status in many patients. Clinical testing of tumor tissue remains essential for a diagnosis of HPV-positive disease.