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Human papillomavirus (HPV) infections are responsible for a continually growing number of head and neck cancer (HNC) cases, with the incident rate overtaking that of HPV-related cervical cancers in the United States. Most HPV-related HNC cases arise in the oropharynx, and although they have a better 5-year survival rate than non-HPV-related HNC patients (80% compared to 50%), de-escalating treatment in all HPV(+) patients in an attempt to improve quality of life led to unacceptable results. Studying molecular subtypes of HPV(+) HNC can help to identify treatment regimens tailored to each patient’s tumor characteristics. We synthesized information from several studies of HPV(+) HNC subtypes, and describe three main groups that differ by their immune cell content, level of keratinocyte differentiation, degree of epithelial-to-mesenchymal transition, probability of HPV integration, oxidoreductase activity and stromal cell (e.g., cancer-associated fibroblast) content. The differences have important implications for local or distant recurrence, treatment response and survival.

Until recently, research on the molecular signatures of Human papillomavirus (HPV)-associated head and neck cancers mainly focused on their differences with respect to HPV-negative head and neck squamous cell carcinomas (HNSCCs). However, given the continuing high incidence level of HPV-related HNSCC, the time is ripe to characterize the heterogeneity that exists within these cancers. Here, we review research thus far on HPV-positive HNSCC molecular subtypes, and their relationship with clinical …