Biologie défavorable dans la tête et le cou SCC: HPV- maladie oropharyngée négative, p16- négatif, s...

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ID	`RF-HNSCC-HIGH-RISK-BIOLOGY`
Type	Signal d’alerte
État	reviewed 2026-04-26 \| pending_clinical_signoff
Maladies	`DIS-HNSCC`
Sources	`SRC-NCCN-NSCLC-2025`

Origine du drapeau rouge

Définition	Adverse biology in head-and-neck SCC: HPV-negative oropharyngeal disease, p16-negative, smoking >10 pack-years with HPV+ disease (intermediate-risk), extranodal extension, positive surgical margins, or PD-L1 CPS ≥20 in metastatic context — each shifts adjuvant intensification (chemo-RT vs RT alone) or 1L choice (pembrolizumab mono vs pembrolizumab + chemo).
Direction clinique	intensifier
Catégorie	high-risk-biology

Logique de déclenchement

{
  "any_of": [
    {
      "all_of": [
        {
          "finding": "primary_site",
          "value": "oropharynx"
        },
        {
          "finding": "hpv_p16_status",
          "value": "negative"
        }
      ]
    },
    {
      "finding": "extranodal_extension",
      "value": true
    },
    {
      "finding": "positive_surgical_margins",
      "value": true
    },
    {
      "all_of": [
        {
          "finding": "metastatic_disease",
          "value": true
        },
        {
          "comparator": ">=",
          "finding": "pdl1_cps",
          "threshold": 20
        }
      ]
    },
    {
      "all_of": [
        {
          "finding": "hpv_p16_status",
          "value": "positive"
        },
        {
          "comparator": ">",
          "finding": "smoking_pack_years",
          "threshold": 10
        }
      ]
    }
  ],
  "type": "biomarker"
}

Notes

HPV / p16 status is the dominant prognostic biomarker in oropharyngeal SCC: HPV+ have 5-yr OS ~80% vs 50% HPV-negative. RTOG-0129 stratified HPV+ smokers (>10 pack-years) as intermediate-risk — current trials (NRG-HN005) test de-escalation only in HPV+ low-smoker patients. Extranodal extension or positive margins post-resection: indication for cisplatin + RT adjuvant (RTOG 9501, EORTC 22931 — OS benefit only in this high-risk subset). Metastatic / R/M HNSCC: PD-L1 CPS ≥20 → pembrolizumab monotherapy (KEYNOTE-048, OS 14.9 vs 10.7 mo); CPS 1–19 → pembrolizumab + 5-FU + platinum; CPS <1 → EXTREME (cetuximab + cis + 5-FU).

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