Epidemiology and survival of HPV‐related tonsillar carcinoma

Abstract

The aim of this study was to determine the proportion of human papilloma virus (HPV)-positive cases in tonsillar carcinomas and investigate its development over the last decade. Further aim was to show the oncologic results in accord to HPV status and various treatment modalities. A retrospective study was conducted between 2000 and 2012 and included 275 patients treated for tonsillar carcinoma. P16 immunohistochemistry was used as a surrogate marker for HPV-associated carcinogenesis. A total of 101 (36.7%) patients proved to be p16 positive and 174 p16 negative. 80.2% of the p16-positive cases presented with T1-2 tumor. Of the early-stage patients, 79% of the p16-positive and 52.3% of the p16-negative presented with lymph node metastases. The percentage of p16-positive patients increased from 23.2% in the period 2005–2007 to 58.6% in the period 2010–2012 in the whole population and from 30.9% to 76.9% in T1-2 carcinomas. Early T-category p16-positive carcinomas had significantly better disease-specific survival (92.4% vs. 75.5%, P = 0.007) and overall survival (OS, 79.6% vs. 54.3%, P < 0.001) compared to p16-negative tumors. This study showed an increase in the percentage of p16-positive patients in tonsillar carcinoma from 23.2% in the years between 2005 and 2007 to 58.6% between 2010 and 2012. The majority (80.2%) of p16-positive patients presented with early T-category tumor but most of these (79.0%) had also lymph node metastases. Nevertheless, p16-positive patients had excellent oncologic results after surgery and adjuvant radiotherapy and could be considered for de-escalation of treatment.

Investigation of the presence of HPV related oropharyngeal and oral tongue squamous cell carcinoma in Mozambique

“…Though improving significantly, the current life expectancy in Mozambique is 52 years [21]. A recent study from Germany evaluating 275 patients with tensile cancer demonstrated a median age of 56 and 59 for p16 positive and negative tumors, respectively [22]. An evaluation of the burden of potentially HPV associated OP and OC cancers in the US showed only 3% of tonsil tumors present before 40 years of age [23].…”

“…Our data’s average age coincided with both of these studies (59y for OP and 52y for OT), but a significant portion of people in Mozambique, may not live long enough to develop this cancer. Secondly, the report from Germany noted 80% of the p16 positive tumors presented as T1 or T2 tumors [22]. In discussions with otolaryngologists in Maputo, many patients who do present to the hospital with head and neck cancers do so at such a late stage that biopsy is often not performed and patients are generally palliated with a tracheosotomy.…”

Adverse effect of smoking on prognosis in human papillomavirus–associated oropharyngeal carcinoma

“…The majority of oropharyngeal carcinomas diagnosed today is related to a previous human papillomavirus (HPV) infection . HPV‐positive tumors represent a distinct category with specific biology and oncogenesis.…”

The role of human papillomaviruses in cancer progression

“…In the last decade the incidence of HPV related OPCs have doubled in number of patients and therefore more attention has drawn to these cancer types. [114] HPV positive oropharyngeal cancers are mainly associated with oral sex and rare p53 mutation. [115] Interestingly HPV infection was shown to improve the prognosis of OPC with better survival is reported in HPV positive OPCs [116] and therefore these patients may have a chance to benefit from a less intense treatment strategy.…”