Impact of Co-Morbid Immunocompromise in HPV-Associated Oropharyngeal Squamous Cell Carcinoma

To characterize the survival and morbidity associated with immunocompromised status in patients with surgically resected Human Papillomavirus positive oropharyngeal squamous cell carcinoma (HPV + OPSCC).

We reviewed patients with surgically resected HPV + OPSCC at a tertiary institution between 2000 and 2023. The survival and morbidity associated with an immunocompromised status were assessed with multivariable Cox proportional hazards models controlling for patient, tumor, and treatment characteristics.

Among 278 patients with HPV+ OPSCC that met inclusion criteria, 14 patients were immunocompromised. Causes of immunocompromise: 4, leukemia or lymphoma; 3, organ transplantation; 3, medically immunosuppressed; 2, HIV; 2, myelodysplastic syndrome and pancytopenia. Adjusting for covariates, the immunocompromised patient group had significantly worse overall survival (64.3% vs. 91.7%; HR 4.12, 95% CI: 1.14-14.90, p < 0.005) compared to the non-compromised group. The immunocompromised patient group did not have a significantly different postoperative length of stay (3.96 vs. 3.5 days; aβ 0.66, 95% CI: -1.30 to 2.64).

In this small, heterogeneous cohort of surgically resected HPV + OPSCC, immunocompromised status was associated with significantly worse overall survival; however, these exploratory findings should be interpreted cautiously.