A retrospective cohort study confirms mounting data that increasing nodal disease burden increases circulating tumor HPV-DNA levels (think: more is more), while–more interestingly–signs of aggressive disease such as perineual invasion and extranodal extension were significantly associated with lower ctHPV-DNA levels (think: bad is occult), the latter postulated to be due to an association with known adverse genetic signatures of lower tumor HPV copy numbers and greater HPV genomic integration. | Birkenbeuel, JAMA Otolaryngol Head Neck Surg 2026
