Antibody responses to cancer antigens identify patients with a poor prognosis among HPV-positive and HPV-negative head and neck squamous cell carcinoma patients

PURPOSE: The identification of high-risk patients within Human Papillomavirus (HPV) positive and negative head and neck squamous cell carcinoma patients is needed for improved treatment and surveillance strategies. In this study, we set out to discover Antibody responses (AR) with prognostic impact in head and neck squamous cell carcinoma (HNSCC) stratified by HPV-status. EXPERIMENTAL DESIGN: A fluorescent bead-based multiplex serology assay to 29 cancer antigens (16 cancer-testis antigens, 5 cancer-retina antigens, 8 oncogenes) and 29 HPV-antigens was performed in samples of 362 HNSCC patients from five independent cohorts (153 HPV-positive, 209 HPV-negative). A multivariable cox proportional hazard model with bootstrapping (M=1000) was used for validation of prognostic antibody responses. RESULTS: AR to any of the cancer antigens were found in 257/362 patients (71%). In HPV-negative patients, antibody responses to to c-myc, MAGE-A1, -A4 and Rhodopsin E2 (combined as ARhigh risk) were significantly associated with shorter overall survival. In HPV-positive patients antibody responses to IMP-1 were discovered as a negative prognostic factor. ARhigh risk (HR=1.76) and antibody responses to IMP-1 (HR=3.28) were confirmed as independent markers for a poor prognosis in a multivariable Cox proportional hazard model with bootstrapping (M=1000). CONCLUSION: We identified AR to cancer antigens that associate with a dismal prognosis in HNSCC patients beyond HPV-positive-status. ARhigh risk may be used to detect HPV-negative patients with an extraordinarily bad prognosis. Most importantly, AR to IMP-1 may serve as a marker for a subgroup of HPV-positive patients that present with a poor prognosis similar to that in HPV-negative patients.