BACKGROUND:The prevalence and prognostic value of human papillomavirus-related oropharyngeal squamous cell carcinoma (OPSCC) in Japan has not been evaluated. METHODS: Over a 12-year period, the authors used immunohistochemistry to evaluate the expression of p16 (a cyclin-dependent kinase inhibitor and tumor suppressor) in samples from 173 patients with OPSCC at a single institution and to determine its prevalence and influence on disease prognosis. RESULTS: The prevalence of p16-positive OPSCC was 33.7% in tonsillar carcinoma, 28.6% in tongue base carcinoma, 0% in posterior wall carcinoma, and 18.8% in soft palate carcinoma. The prevalence of p16-positive OPSCC tumors increased from 15.2% during 2000 to 2003 up to 33.3% during 2008 to 2011; during the same periods, among nonsmokers, the prevalence of p16-positive OPSCC tumors increased from 21.2% to 27.8%; and, among nondrinkers, prevalence increased from 6.1% to 25%. Multivariate analysis identified p16 expression and alcohol consumption as significant, independent prognostic markers of OPSCC. CONCLUSIONS: The current results suggest that the incidence of human papillomavirus-related OPSCC in Japan is increasing and indicate that p16 expression and alcohol consumption may be significant prognostic markers of survival for patients with OPSCC in Japan. Cancer 2013;119:2005-11. V C 2013 American Cancer Society.KEYWORDS: oropharyngeal carcinoma, head and neck squamous cell carcinoma, p16, human papillomavirus, alcohol consumption, Japan.
INTRODUCTIONTobacco smoking and excessive alcohol consumption traditionally have been considered the main risk factors for head and neck squamous cell carcinoma (HNSCC). Oral and oropharyngeal squamous cell carcinoma (OPSCC) are major causes of morbidity, with an estimated annual worldwide incidence of 300,000. Evidence suggests that human papillomavirus (HPV) infection is also an independent risk factor, especially for OPSCC. [1][2][3][4][5][6] Most of the available data on HPVassociated SCC were generated in the United States and Europe. The incidence of HPV-associated malignancies, such as carcinoma of the uterine cervix, varies substantially in different regions of the world; for example, the incidence of HPVrelated cervical/uterine cancer is higher in African and Asian countries than in European countries. 7 Although eastern Asia, including Japan, is known for high epidemics of several oncogenic viral infections, such as Epstein-Barr virus and hepatitis B virus, the status of HPV-related SCC in Asia has not been elucidated.The diagnosis of HPV-related OPSCC can be made using polymerase chain reaction (PCR) analysis to detect HPV DNA 2 ; however, although this is a logical approach, it is quite challenging in clinical practice. Other diagnostic methods are HPV in situ hybridization or quantification of expression of the HPV oncoproteins E6 and E7, which has the major advantage of detecting transcriptionally active HPV. These assays, however, are cumbersome, costly, and require highly trained personnel. 8 A more feasible diagnos...