***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE Recent increases in incidence and survival of oropharyngeal cancers in the United States have been attributed to human papillomavirus ( HPV ) infection , but empirical evidence is lacking . PATIENTS AND METHODS HPV status was determined for all 271 oropharyngeal cancers ( 1984 - 2004 ) collected by the three population -based cancer registries in the Surveillance , Epidemiology , and End Results ( SEER ) Residual Tissue Repositories Program by using polymerase chain reaction and genotyping ( Inno-LiPA ) , HPV16 viral load , and HPV16 mRNA expression . Trends in HPV prevalence across four calendar periods were estimated by using logistic regression . Observed HPV prevalence was reweighted to all oropharyngeal cancers within the cancer registries to account for nonr and om selection and to calculate incidence trends . Survival of HPV-positive and HPV-negative patients was compared by using Kaplan-Meier and multivariable Cox regression analyses . RESULTS HPV prevalence in oropharyngeal cancers significantly increased over calendar time regardless of HPV detection assay ( P trend < .05 ) . For example , HPV prevalence by Inno-LiPA  increased from 16.3 % during 1984 to 1989 to 71.7 % during 2000 to 2004 . Median survival was significantly longer for HPV-positive than for HPV-negative patients ( 131 v 20 months ; log-rank P < .001 ; adjusted hazard ratio , 0.31 ; 95 % CI , 0.21 to 0.46 ) . Survival significantly increased across calendar periods for HPV-positive ( P = .003 ) but not for HPV-negative patients ( P = .18 ) . Population -level incidence of HPV-positive oropharyngeal cancers increased by 225 % ( 95 % CI , 208 % to 242 % ) from 1988 to 2004 ( from 0.8 per 100,000 to 2.6 per 100,000 ) , and incidence for HPV-negative cancers declined by 50 % ( 95 % CI , 47 % to 53 % ; from 2.0 per 100,000 to 1.0 per 100,000 ) . If recent incidence trends continue , the annual number of HPV-positive oropharyngeal cancers is expected to surpass the annual number of cervical cancers by the year 2020 . CONCLUSION Increases in the population -level incidence and survival of oropharyngeal cancers in the United States since 1984 are caused by HPV infection The burden of squamous cell carcinoma of the head and neck ( SCCHN ) is greater for blacks than for whites , especially in oropharyngeal cases . We previously showed retrospectively that disease-free survival was significantly greater in white than in black SCCHN patients treated with chemoradiation  , the greatest difference occurring in the oropharyngeal subgroup . Oropharyngeal cancer is increasing in incidence and in its association with human papillomavirus ( HPV ) infection ; HPV-positive oropharyngeal cancer patients have significantly better outcomes ( versus HPV-negative ) . These collective data led to the present analyses of overall survival ( OS ) in our retrospective cohort and of OS and HPV status ( tested prospect ively in pretreatment biopsy specimens ) in the phase 3 , multicenter TAX 324 trial of induction chemotherapy followed by concurrent chemoradiation in SCCHN patients .  Median OS in the retrospective cohort of 106 white and 95 black SCCHN patients was 52.1 months ( white ) versus only 23.7 months ( black ; P = 0.009 ) , due entirely to OS in the subgroup of patients with oropharyngeal cancer—69.4 months ( whites ) versus 25.2 months ( blacks ; P = 0.0006 ) ; no significant difference by race occurred in survival of non-oropharyngeal SCCHN ( P = 0.58 ) . In TAX 324 , 196 white patients and 28 black patients could be assessed for HPV status . Median OS was significantly worse for black patients ( 20.9 months ) than for white patients ( 70.6 months ; P = 0.03 ) and dramatically improved in HPV-positive ( not reached ) versus HPV-negative ( 26.6 months , 5.1 hazard ratio ) oropharyngeal patients ( P < 0.0001 ) , 49 % of whom were HPV-16 positive . Overall , HPV positivity was 34 % in white versus 4 % in black patients ( P = 0.0004 ) . Survival was similar for black and white HPV-negative patients ( P = 0.56 ) . This is the first prospect i ve assessment of confirmed HPV status in black versus white SCCHN patients . Worse OS for black SCCHN patients was driven by oropharyngeal cancer outcomes , and that for black oropharyngeal cancer patients by a lower prevalence of HPV infection . These findings have important implication s for the etiology , prevention , prognosis , and treatment of SCCHN OBJECTIVE to determine whether the favorable outcome associated with human papillomavirus ( HPV ) 16-positive oropharyngeal cancer is related to a patient 's adaptive immunity . SETTING academic medical center . PATIENTS forty-seven of 66 previously untreated patients ( 6 of 20 patients with stage III and 41 of 46 with stage IV cancer ) in a prospect i ve clinical trial of chemoradiotherapy . INTERVENTION all patients were treated with a single course of neoadjuvant chemotherapy followed by either surgery ( for nonresponders ) or chemoradiotherapy . MAIN OUTCOME MEASURES pretreatment levels ( percentages and absolute counts ) of CD3 , CD4 , CD8 , natural killer , and B cells and overall white blood cell counts were measured by flow cytometry . Correlations of subsets with HPV-16 status , tumor subsite , cancer stage , T class , N class , smoking status , performance status , sex , response to chemoradiotherapy , p53 mutation type , epidermal growth factor receptor expression , and disease-specific and overall survival were determined . RESULTS after a median follow-up of 6.6 years , improved survival was associated with an elevated percentage of CD8 cells ( P = .04 ) , a low CD4:CD8 ratio ( P = .01 ) , low epidermal growth factor receptor expression ( P = .002 ) , and HPV status ( P = .02 ) . The percentage of CD8 cells was significantly higher ( P = .04 ) and the CD4:CD8 ratio was significantly lower ( P = .02 ) in HPV-16-positive patients . A higher percentage of CD8 cells was associated with response to induction chemotherapy ( P = .02 ) and complete tumor response after chemoradiotherapy ( P = .045 ) . CONCLUSION these findings confirm previous correlations of outcome with circulating CD8 cell levels and support the conjecture that improved adaptive immunity may play a role in the favorable prognosis of patients with HPV-16-positive cancers Patients with human papillomavirus DNA positive ( HPVDNA+ ) oropharyngeal squamous cell carcinoma ( OSCC ) have better clinical outcome than those with HPV DNA negative ( HPVDNA− ) OSCC upon intensive oncological treatment . All HPVDNA+ OSCC patients may not require intensive treatment , however , but before potentially deintensifying treatment , additional predictive markers are needed . Here , we examined  HPV , p16INK4a , and CD44 in OSCC in correlation to clinical outcome . Pretreatment tumors from 290 OSCC patients , the majority not receiving chemotherapy  , were analyzed for HPV DNA by Luminex and for p16INK4a and CD44 by immunohistochemistry . 225/290 ( 78 % ) tumors were HPVDNA+ and 211/290 ( 73 % ) overexpressed p16INK4a , which correlated to presence of HPV ( P < 0.0001 ) . Presence of HPV DNA , absent/weak CD44 intensity staining correlated to favorable 3‐year disease‐free survival ( DFS ) and overall survival ( OS ) by univariate and multivariate analysis , and likewise for p16INK4a by univariate analysis . Upon stratification for HPV , HPVDNA+ OSCC with absent/weak CD44 intensity presented the significantly best 3‐year DFS and OS , with > 95 % 3‐year DFS and OS . Furthermore , in HPVDNA+ OSCC , p16INK4a+ overexpression correlated to a favorable 3‐year OS . In conclusion , patients with HPVDNA+ and absent/weak CD44 intensity OSCC presented the best survival and this marker combination could possibly be used for selecting patients for tailored deintensified treatment in prospect i ve clinical trials PURPOSE To determine the potential efficacy of combining cetuximab with chemotherapy in patients with advanced nodal disease , we conducted a phase II trial with induction chemotherapy ( ICT ) consisting of six weekly cycles of paclitaxel 135 mg/m(2 ) and carboplatin ( area under the curve = 2 ) with cetuximab 400 mg/m(2 ) in week 1 and then 250 mg/m(2 ) ( PCC ) . PATIENTS AND METHODS Forty-seven previously untreated patients ( 41 with oropharynx primaries ; 33 men , 14 women ; median age , 53 years ; performance status of 0 or 1 ) with squamous cell carcinoma of the head and neck ( SCCHN ; T1 - 4 , N2b/c/3 ) were treated and evaluated for clinical and radiographic response . After ICT , patients underwent risk-based local therapy , which consisted of either radiation , concomitant chemoradiotherapy , or surgery , based on tumor stage and site at diagnosis . Results After induction PCC , nine patients ( 19 % ) achieved a complete response , and 36 patients ( 77 % ) achieved a partial response . The most common grade 3 or 4 toxicity was skin rash ( 45 % ) , followed by neutropenia ( 21 % ) without fever . At a median follow-up time of 33 months , locoregional or systemic disease progression was observed in six patients . The 3-year progression-free survival ( PFS ) and overall survival ( OS ) rates were 87 % ( 95 % CI , 78 % to 97 % ) and 91 % ( 95 % CI , 84 % to 99 % ) , respectively . Human papillomavirus ( HPV ) 16 , found in 12 ( 46 % ) of 26 biopsies , was associated with improved PFS ( P = .012 ) and OS ( P = .046 ) . CONCLUSION ICT with weekly PCC followed by risk-based local therapy seems to be feasible , effective , and well tolerated . PFS is promising , and this sequential treatment strategy should be further investigated . Patients with HPV-positive tumors have an excellent prognosis The incidence of base of tongue cancer is increasing in Sweden and the proportion of human papillomavirus ( HPV ) positive cancer has increased in Stockholm , Sweden . Between 2006 and 2007 , 84 % of base of tongue cancer cases in Stockholm were HPV-positive . The objective of this study was to assess the impact of HPV status on prognosis for base of tongue cancer patients . One-hundred and nine patients were diagnosed with base of tongue cancer between 1998 and 2007 in Stockholm County and 95 paraffin-embedded diagnostic tumor biopsies were obtained and tested for HPV by PCR .  Eighty-seven patients had available biopsies , were treated with intention to cure and could be included in the survival analysis . Age , sex , TNM-stage , stage , treatment and survival were recorded from patient charts . Kaplan-Meier curves were used to present survival data . In multivariable analyses , a Cox proportional hazards model was used to adjust for covariates . In total 68 ( 78 % ) tumor biopsies from the 87 included patients were HPV DNA positive . Kaplan-Meier estimates showed that the overall survival for patients with HPV-positive cancer was significantly better ( p = 0.0004 ) , ( log-rank test ) than that of patients with HPV-negative cancer . Patients with HPV-positive tumors also had significantly better disease-free survival ( p = 0.0008 ) , ( log-rank test ) than those with HPV-negative tumors . These results further strengthen the option to consider HPV-status when planning prospect i ve studies on treatment for base of tongue cancer PURPOSE To determine the prognostic importance of p16 and human papillomavirus ( HPV ) in patients with oropharyngeal cancer treated on a phase III concurrent chemoradiotherapy trial . PATIENTS AND METHODS Patients with stage III or IV head and neck squamous cell cancer were r and omly assigned to concurrent radiotherapy and cisplatin with or without tirapazamine . In this sub study , analyses were restricted to patients with oropharyngeal cancer . p16 was detected by immunohistochemistry , and HPV was detected by in situ hybridization and polymerase 
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The HR for HPV– OPSCC was higher for radiation than surgery .
Conclusions HPV+ OPSCC has an improved prognosis and lower rates of adverse events when compared with HPV– OPSCC .
HPV– OPSCC had significantly worse outcomes when treated with primary radiation as compared with primary surgery .
There was no statistically significant difference in HRs for HPV+ OPSCC with primary radiation vs primary surgery treatment