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Scientific Oral Presentation

Head and Neck Surgery

Circulating Tumor HPV DNA and Clinicopathologic Factors in Hpv-positive Oropharyngeal Squamous Cell Carcinoma

Monday, October 19, 2026
1:12 PM - 1:18 PM PT
Location: West Exhibit Hall A, Learning Zone 3

    Presenting Author(s)

  • Wyatt Wofford, BS

    MSTP (MD/PhD) Candidate
    Medical University of South Carolina
    Charleston, South Carolina, United States

    • Co-Author(s)

  • Luke L. Driskill, MD

    Luke Driskill
    University of Mississippi Medical Center
    Jackson, Mississippi, United States

  • TD

    Theodore Dowd, n/a

    Medical Student
    UAB Heersink School of Medicine
    Birmingham, Alabama, United States

  • MM

    Monica McGrath, n/a

    Ms.
    University of Kentucky College of Medicine, United States

  • Alexandra E. Kejner, MD, FACS

    Associate Professor Head&Neck Surgical Oncology, Microvascular Reconstruction
    Medical University of South Carolina
    Charleston, South Carolina, United States

  • MW

    Melina Windon, MD

    Assistant Professor
    University of Kentucky, United States

    • Senior Author(s)

  • Anne C. Kane, MD

    Associate Professor
    University of Alabama at Birmingham
    Birmingham, Alabama, United States

Introduction: Circulating tumor HPV DNA (ctHPVDNA) is a biomarker with established diagnostic utility in HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). The clinicopathologic factors influencing ctHPVDNA levels and viral load remains ill-defined and under investigated. We aim to evaluate the relationships between ctHPVDNA levels and patient demographic and cancer characteristics.

Methods: An IRB-approved, multi-institutional, retrospective cohort study across four tertiary care academic centers collected data for all patients with p16+ OPSCC and ctHPVDNA testing. Data collected included demographics, staging, and pre- and post-treatment ctHPVDNA values and surgical pathologic data collected for those undergoing transoral robotic surgery (TORS, n=57). Comparative analysis was performed.

Results: Of 249 patients, pre-treatment ctHPVDNA was positive in 92.4% (n=230). Pre-treatment positivity was significantly (p < 0.05) associated with age, race, and smoking history. Pre-treatment ctHPVDNA levels were higher in Black patients (p < 0.001) and positively correlated with area-deprivation index (r=0.15, p=0.05). In patients with recurrence, those with regional disease had a higher pre-treatment ctHPVDNA, while mid-range and low-range were associated with distant and local recurrence, respectively (p=0.008). Within the TORS cohort, pre-treatment ctHPVDNA levels had significant associations (p < 0.05) with ECOG3311-risk level, PNI, and size of largest lymph node. Post-operative ctHPVDNA positivity was rare.

Conclusions: Understanding the implications of ctHPVDNA levels may provide a more individualized approach to risk-stratification, treatment, and surveillance of patients with OPSCC. Several relevant demographic and clinicopathologic characteristics were observed to be associated with ctHPVDNA levels in this cohort. These findings support the use of ctHPVDNA as a potentially meaningful augmentation to clinical decision-making and disease monitoring in this patient population.