Persistent HPV16 DNA in Post-Treatment Oral Rinse Associated With Poor Prognosis in HPV-Related Oropharyngeal Carcinoma


Key Points

  • Persistent HPV16 DNA in oral rinses was found in 4% of patients.
  • Persistent HPV16 DNA was associated with significantly poorer disease-free and overall survival.

In a prospective cohort study reported in JAMA Oncology, Rettig et al found that persistent human papillomavirus (HPV) type 16 DNA in post-treatment oral rinses was associated with a poorer prognosis in patients with HPV-related oropharyngeal cancer.

The study included 124 patients treated with curative intent between 2009 and 2013 at four academic tertiary referral cancer centers in the United States who had at least one post-treatment oral rinse sample available.

Persistence and Outcomes

Oral HPV16 DNA was found in 67 patients (54%) at diagnosis and in 6 (5%) after treatment, with 5 (4% of population) of the 6 having positive oral rinses at diagnosis—ie, persistent HPV16 DNA. Overall, 2-year disease-free survival was 92%, and 2-year overall survival was 98%.

Persistent oral HPV16 DNA was associated with significantly worse disease-free survival (hazard ratio [HR] = 29.7, 95% confidence interval [CI] = 9.0–98.2) and overall survival (HR = 23.5, 95% CI = 4.7–116.9). Recurrent disease was observed in each of the 5 patients with persistent oral HPV16 DNA, with 3 having local disease involvement, compared with 9 (8%) of 119 without persistent oral HPV16 DNA, with 1 having local disease involvement. The median time from earliest post-treatment oral HPV16 DNA detection to recurrence was 7.0 months (range = 3.7–10.9 months).

The investigators concluded: “Human papillomavirus type 16 DNA in oral rinses is common at diagnosis but rare after treatment for HPV-[related oropharyngeal carcinoma]. Our data suggest that, although infrequent, persistent HPV16 DNA in post-treatment oral rinses is associated with poor prognosis and is a potential tool for long-term tumor surveillance, perhaps more so for local recurrence.”

Gypsyamber D’Souza, PhD, of Johns Hopkins Bloomberg School of Public Health, is the corresponding author of the JAMA Oncology article.

For full disclosures of the study authors, visit

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