Childhood tonsillectomy alters the primary distribution of HPV‐related oropharyngeal squamous cell carcinoma

Abstract

Objectives: We investigated how tonsillectomy during childhood may influence the distribution of human papillomavirus (HPV) positive cancer of the tonsils in adult life using p16 as a surrogate marker for HPV infection.Study Design: Retrospective observational study.Methods: A total of 280 patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) and known p16 status were eligible for this study. Each participant was called to obtain the childhood tonsillectomy history. Respondents were subgrouped by p16 status and the primary tumor location. Patient demographic and clinical information was analyzed for association with Fisher's exact and Wilcoxon rank sum tests.Location of tumor was modeled using univariate (UVA) and multivariate (MVA) logistic regression with associated odds ratios (OR) and 95% confidence intervals.Results: Of the 280 patients, 115 (41%) were respondents: 104 (90.4%) were p16 positive and 11 (9.6%) were p16 negative. For p16 positive patients, we observed a majority (93%) of intact tonsils in those with tonsil cancer, compared to 45% of intact tonsils in patients with p16 positive cancer elsewhere in the oropharynx (P < .001). MVA logistic regression showed that female gender (OR = 4.16, P = .0675), prior smoking history (OR = 2.6, P = .0367), and intact tonsils (OR = 15.2, P < .0001) were associated with tonsillar OPSCC. Conclusion:We found that patients with p16 positive OPSCC at a non-tonsil site were much more likely to have had prior tonsillectomy vs those with p16 positive OPSCC arising within the tonsil. Nevertheless, we do not advocate tonsillectomies as a public health policy to reduce HPV-related OPSCC. Level of Evidence: 6 K E Y W O R D S human papillomavirus (HPV), p16, tonsil cancer, tonsillectomy Brannon Altenhofen and Todd A. DeWees contributed equally to this study.

Sexual Behaviour and Human Papillomavirus-Positive Oral Cavity and Oropharyngeal Cancer: An Irish Perspective

“…As expected, the majority of HPV-positive OPSCC were located in the tonsils and tongue base, which is likely due to the crypt epithelium present in lymphoid tissue which provides an entry point for HPV [11]. Another potential contributor to the increased incidence of HPV-mediated tonsillar cancer is the decline in tonsillectomy rates over the past 50 years [15]. A recent study found that patients with a HPV-positive OPSCC at a non-tonsil site were much more likely to have had a previous tonsillectomy, suggesting if tonsils are present, they are a risk factor for developing primary tonsillar OPSCC [15].…”

“…Another potential contributor to the increased incidence of HPV-mediated tonsillar cancer is the decline in tonsillectomy rates over the past 50 years [15]. A recent study found that patients with a HPV-positive OPSCC at a non-tonsil site were much more likely to have had a previous tonsillectomy, suggesting if tonsils are present, they are a risk factor for developing primary tonsillar OPSCC [15]. In both groups, oral cavity and OPSCC were more common in males.…”

Epidemiologic distinctions between base of tongue and tonsil oropharyngeal carcinomas

“…The higher proportion of BOT primaries among older individuals is conceivably an inverse function of childhood tonsillectomy rates, which have decreased over recent decades with changing practice patterns and surgical indications. 12,13 Prior analyses have demonstrated that the distribution of cancer among oropharyngeal subsites is modified by the absence of palatine tonsillar tissue, [14][15][16] such that childhood tonsillectomy confers a higher odds of BOT and decreased odds of tonsil subsite. Although the NCDB does not include history of tonsillectomy, extrapolation from NHANES, a representative population-based data set, suggests that odds of a BOT cancer in the NCDB (aOR = 2.9) is similar to the odds of self-reported tonsillectomy in NHANES (aOR = 3.6) for 70+ compared with <50 year olds.…”

Risk Factors for the Development of Malignant Tumors of the Head and Neck

“…Исследование Altenhofen В. показало, что среди пациентов с ВПЧ-положительным статусом рак миндалин отмечается чаще (93%), чем другая локализация рака головы и шеи (45%, р < 0,001). Результаты логистической регрессии показали, что женский пол (ОШ= 4,2, р = 0,0675), курение (ОШ = 2,6, P = 0,0367) и интактные миндалины (ОШ = 15,2, р < 0,0001) связаны с риском развития рака миндалин [55]. Таким образом, полное удаление миндалин (полная, а не частичная тонзиллэктомия) приведет к снижению заболеваемости раком миндалин, связанным с ВПЧ.…”

“…Однако кажется сомнительным, что тотальная тонзиллэктомия повлияет на частоту развития плоскоклеточного рака головы и шеи, несвязанного с ВПЧ, и уменьшает общую частоту возникновения рака головы и шеи. По этой причине тонзиллэктомия как политика Обзор Review общественного здравоохранения для снижения ВПЧ-ассоциированного рака головы и шеи является ошибочной [55]. Кроме того, глоточные миндалины выполняют важные физиологические функции.…”