Circulating tumor HPV-DNA has been explored as a possible additive to surveillance regimens for HPV+ oropharyngeal squamous cell carcinoma (oSCC). This retrospective study asks a novel question: can pre-treatment ctHPV-DNA levels be used to risk stratify and identify cohorts for safe de-escalation strategies (think PSA for prostate cancer)? Across 203 patients receiving definitive treatment for oSCC at Mount Sinai with detectable pretreatment ctHPV-DNA, there was a pretty even split between low (n=58, ≤99 fragments/mL), moderate (n=73, 100-999/mL), and high (n=72, (≥1000/mL) baseline levels. Interestingly, higher baseline ctHPV-DNA levels were significantly correlated with higher T stage, higher N stage, and higher total volume of radiographic disease. On the other hand, there was no correlation with high-risk pathologic features such as LVI, PNI or ECE among the 94 patients undergoing resection, suggesting pretreatment ctHPV-DNA levels may be more correlative of big versus bad disease. | Cooke, JAMA Otolaryngol Head Neck Surg 2025
